IT2 ISOTOPE TRACER TECHNOLOGIES INC. CHAIN OF CUSTODY Analytical Services Request Form 1 2 3 Client Info Sampling & Details Chain of Custody Leave this field empty Client Information Company Name * Office Address * Project Manager * Project # * PHONE # * FAX # PO # * Service Requested Note: all TAT Quoted material is in business days. Service Requested Regular Rush Report Format / Distribution Method Email (Req) Fax File Type * PDF Excel Report Email 1 (Required) + Add Another Email Invoicing Instructions Provide billing details. Invoicing Email (For Billing) * Invoicing Comments / Billing Address * Next Step → Sampling Information & Analysis Request Select Group Analysis to enable configuration. + Add Analysis Request ← Previous Next Step → Instructions / Comments Regulatory Questions Regulated DW System? If YES, an authorized drinking water COC must be used. Yes No Potable for human consumption? Yes No Sample Condition Frozen Cold Cooling Initiated Ambient Observations Chain of Custody Sampled By (Name) * Date & Time (Required) * Relinquished By (Name) Date & Time Reception Received By Date & Time (YYYY-MM-DD) Received at Lab By Date & Time (YYYY-MM-DD) Digital Signature Authorization (Required) Sign below or upload an image. Upload Image Clear / Reset ⚠️ Error: Digital Signature is required. Please sign above or upload an image. This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply. ← Previous SUBMIT FORM Select Analysis ×
