Date of Collection
Date of Collection
Contact Name
Contact Name
Contact Phone Number
Contact Phone Number

Chain of Custody:

You can also fax an updated copy of your Chain of Custody to (206)352-7178. Or, you can email an updated Chain of Custody to us.

Notes:

Please make sure to include the Sample ID for each additional analysis requested.

If you fax or email your updated Chain of Custody, please specify the additional analysis for each sample. You must also initial and date each request in the comments field.