Chain_of_Custody.pdf
PDF 170 KB Posted
- Attached to
- Laboratory Testing Services
- Solicitation number
- 262830RM
- Issued by
- Sarasota County, Siesta Key CDP, Florida
About this file
This is a Chain of Custody Form example provided as an attachment to Sarasota County Utilities Department's laboratory testing services solicitation. The form establishes standardized procedures for tracking water and wastewater samples from collection through laboratory analysis, with specific protocols for sample handling, preservation, and documentation. The example form identifies the laboratory (Laboratory 1301 Cattlemen Rd, Sarasota, FL), client (Sarasota County Utilities Department), and sample collection parameters including sample matrix types (drinking water, groundwater, surface water, soil, sediment, or sludge) and sample types (grab or composite). The form requires documentation of various analyses including TDS, chloride, sulfate, BOD, CBOD, nutrients (NOX, NO2, NO3, NH3, TKN, TP), cyanide, and metals (Al, As, Ca, Cd, Cr, Cu, Fe, Pb, Mg, Mn, Mo, Ni, K, Se, Na, Zn) with specified preservatives for each parameter such as plain, sulfuric acid, ascorbic acid, and nitric acid solutions.
The Chain of Custody Form mandates that samples be maintained at a maximum temperature of 6°C (42.8°F) following collection and establishes three documented transfer points tracking relinquishment and receipt by date and time. All sample bottles must be labeled with identification, preservation information, sample type, and client ID prior to collection, with collectors required to add collection date and time, sampler identification, and field numbers using permanent black ink. The form emphasizes that the client bears responsibility for documentation of sampling events and requires notation of any special sampling circumstances. This standardized documentation process ensures compliance with Florida Administrative Code and EPA regulations for laboratory testing services contracted by the County across its water reclamation facilities, water treatment plants, and solid waste disposal complex.
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Text version
ATTACHMENT B CHAIN OF CUSTODY FORM
EXAMPLE LABORATORY
1301 Cattlemen Rd Sarasota, Fl, 34232
(941) 555-8888
(941) 555-8888 fax www.examplelaboratory.com
Client: Sarasota County Utilities Department 1255 T. Mabry Carlton Parkway Venice, FL 34292
(941) 650-XXXX
(941) 480-XXXX fax
Project Name:
Purchase Order Number:
Laboratory Submission #:
Station
ID:
Sample Matrix2
Sample Type1
Analysis Requested:
Laboratory Sample #
TDS, Chloride, sulfate
BOD,
CBOD
NOX
NO2,
NO3
NH3 TKN
TP
CN Al, As, Ca, Cd, Cr, Cu, Fe, Pb, Mg, Mn, Mo, Ni, K, Se, Na, Zn
Preservative:
Plain
Plain Plain 1:4
H2SO4
1:4
H2SO4
Ascorbic Acid
1:4 HNO3
Example WW Grab Date & Time:
Date & Time:
Date & Time:
Date & Time:
Date & Time:
1 “Sample Type” is used to indicate whether the sample was a grab (G) or whether it was a composite (C).
2 “Sample Matrix” is used to indicate whether the sample is being discharged to drinking water (DW), groundwater (GW), surface water (SW), soil, sediment (SDMNT), or sludge (SLDG).
3 “Container Type” is used to indicate whether the container is plastic (P) or glass (G).
4 Sample must be refrigerated or stored in wet ice after collection. The maximum temperature during storage should be 6°C (42.8°F).
Under “Preservative,” list any preservatives that were added to the sample container.
Instructions:
1. Each bottle has a label identifying sample ID, premeasured preservative contained in the bottle, sample type, client ID, and parameters for analysis.
2. The following information should be added to each bottle label after collection with permanent black ink: date and time of collection, sampler’s name or initials, and any field number or ID.
3. All bottles not containing preservative may be rinsed with appropriate sample prior to collection.
4. The client is responsible for documentation of the sampling event. Please note special sampling events on the sample custody form.
1 Collector – Relinquished by: Date: Time: Received By: Date: Time:
2 Relinquished by: Date: Time: Received By: Date: Time:
3 Relinquished by: Date: Time Received By: Date: Time
Laboratory Sample Acceptability: pH <2 : �
LAB Temperature:
LAB Temperature:
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