DRAFT Exhibit B 2026.pdf
PDF 118 KB Posted
- Attached to
- Analytical Services
- Solicitation number
- BSA478026
- Issued by
-
Department of Energy Office of Science
About this file
This is a Chain of Custody Form template used by Brookhaven National Laboratory to document the transfer and handling of samples throughout the sampling, analysis, and disposal process.
The form captures comprehensive sample identification and tracking information across three primary parties: Analysis Requestor, Sampling Contractor, and Analytical Laboratory. Required fields vary by sample type and include unique identifiers (UID), sample type designation (Environmental, Bioassay, RadCon, Waste, or Other), site location or building number, collection date and time in military format, sample matrix, and BNL life number and account number for all samples. The form accommodates multiple sample entries with columns for site ID, depth, collection type, matrix description, container information, volume/units, and preservative details. Chain of custody documentation requires three signature blocks showing relinquishment and receipt of samples with corresponding dates and times, establishing accountability at each transfer point. Additional form sections specify analysis requirements including turn-around time options (Rush/1 Day, 7 Days, 14 Days, 30 Days, or Other), sample disposal instructions (Return to Client, Lab Disposal, or Archive with specified retention period), and data package format (Full or Summary). The form includes checkboxes for specific analytical methods such as Alpha/Beta, Tritium, Gamma, Strontium 90, 8260, 8270, PFAS, Metals, and 1633. Detailed instructions on the reverse side define required field content, sample type codes, collection type codes, matrix abbreviations, container type designations, and specific formatting requirements for depth measurements, time recording, and sample identification numbering.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| DRAFT Exhibit E 2026.pdf | ||
| DRAFT Exhibit F and Tech.pdf | ||
| DRAFT Exhibit D.pdf | ||
| DRAFT Exhibit C and Qualifiers 2026.pdf | ||
| DRAFT Exhibit A 2026.pdf | ||
| DRAFT Exhibit H 2026.pdf | ||
| DRAFT Exhibit G 2026.pdf | ||
| DRAFT Fee Schedule.xlsx | XLSX spreadsheet | |
| DRAFT SOW 26 Jan 2026.pdf |
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Text version
Exhibit B
Brookhaven National Laboratory
Chain of Custody Form
DRAFT
Name: Name: Name:
Life: No: Ext. Contact: Address:
Acct. No: Dept: Phone: City: St: Zip:
Email Reports To: Email/Fax: Contact:
1 Sampler: Phone:
2 Email/Fax:
Project Name: Project Manager: Field Engineer:
Type Sample Information Additional Sample Information Site ID/Bldg/Life # Depth/RWP Date Time Matrix Name/Description Cont. Vol./Units Preservative
1 Relinquished By/Date/Time 2 Relinquished By/Date/Time 3 Relinquished By/Date/Time
Print Print Print
Signature Signature Signature 1 Received By/Date/Time 2 Received By/Date/Time 3 Received By/Date/Time
Print Print Print
Signature Signature Signature
Analysis Requested By Sampling Contractor Analytical Laboratory
P.O. # _____________________
Comments:
Analysis Requested
SAMPLING CHAIN OF CUSTODY
Chain of Custody No.
Contractor Lab Sample Disposal:
❏ Return To Client ❏ Disposal by Lab ❏ Archive For ______ Months
Turn-Around Time Required:
❏ Rush (1 Day) ❏ 14 Days ❑ 30 Days ❑ 7 Days ❑ Other ( )
Distribution (1) - Stays with Sample (1) - Field Copy - (Sampler)
BNL F 3101I (rev. 02/25)
A lp ha /B et a
Tr iti um
G am m a
S tr on tiu m
Samples Securely Stored ❑
P
FA
S
M et al s
Data Package: ❏ Full ❏ Summary
Smp CollUiD # of ContCont. Type
Page _____ of _______
Pts. 1-2 Face � EDGE GLUE THIS EDGE �
� EDGE GLUE THIS EDGE �
Instructions:
1. REQUIRED FIELDS: Environmental, Waste – UID, Sample Type (E or W), Site ID, Depth, Date, Time, Matrix Bioassay – UID, Sample Type (B), Collection Type, Life #, RWP # (except Initial and Termination), Date, Time, Matrix RadCon – UID, Sample Type (R), Site ID or Bldg., Date, Time, Matrix Other – UID, Sample Type (O), Date, Time, Matrix
2. Fill in COC No. on any continuing pages
3. BNL life number and account number are REQUIRED FIELDS for all samples.
LID: For Laboratory use only. Do not use these fields.
SAMPLE: Sample ID is Chain of Custody number + UID, hyphenated (e.g., 5109-001)
SAMPLE TYPE: E - Environmental B - Bioassay O - Other W - Waste R - RadCon
COLLECTION TYPE: C - Composite G - Grab P - Pump B - Bail I - Initial R - Routine T - Termination If blank, default is Grab. (I,R,T are for Bioassay samples only)
SITE ID: (environmental samples) is the sample location ID. See EI-SOP-001, Sample Location Identification, for listing of routine Site IDs.
BLDG: (bioassay and radcon samples) is the standard BNL building number. Room number, if applicable, record in Description field
DEPTH: (environmental samples) is sample depth below land surface in FEET.
DO NOT WRITE UNITS
WELLS - if no depth is indicated, use the midpoint of the screen SOIL, SEDIMENT - use depth range (example, 0-0.5) OTHER SAMPLES - if depth is not applicable (e.g., treatment systems), record as 0
RWP: (bioassay samples) is the Rad Worker Permit number.
DATE: Month/Day/Year (MM/DD/YY, e.g., 12/07/01)
TIME: Military time, no colons (e.g., 1430). For blanks, record as 0000.
For time range, write start time. Record stop time in Description field.
MATRIX: A - Air E - Smear L - Sludge P - Particulate T - Other animal B - Asbestos F - Fish M - Marinelli Q - Wipe U - Urine C - Charcoal G - Silica Gel N - Solvent R - Other V - Vegetation D - Deer H - TLD O - Oil S - Soil/Sediment W - Water
CONTAINER TYPE: AG - Amber glass GE - Glycene envelope ST - Sorbent Tube P - Plastic CG - Clear glass SA - Septum lid, amber glass SC - Septum lid, clear glass C - Can
BNL F 3101G (rev. 12/24)
Pts. 1-2 Backer
| Exhibit B |
| COC and instructions |
File details come from the government source that posted it. Updated .