CHAIN OF CUSTODY RECORD
   
 
Report Information Invoice information  
   Company:      Company:    
   Contact:      Contact:    
   Address:      Address:    
   Phone:      Phone:    
   Fax:      Fax:    
   Email:      Email:    
 
   
         
    Additional Reporting Information Special Instructions by Client    
   
Rush: Please contact the laboratory to confirm rush dates and times before submitting samples.

Upon filling out this section, client accepts that surcharges will be attached to this analysis.
Date Required
Authorized Signature
KML rush Acceptance Signature
   
         
    # Sample Identification Date Sampled Quantity Sample Lot Number Test Ordered    
       
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      All samples must be clearly identified and all applicable areas of the submission sheet completed. Improper or incomplete sheets may result in delayed sample processing.  KML will use AOAC Official methods by default. USP and BAM methods need to requested prior to sample submission to make the necessary mediums that are required.    
         
   
Relinquished by: Received by: Date/Time Purpose of Change/Remarks
 
   
         
   
Please enter Security Code    here >>  
   
         
               
         
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