Also: Please Read
Lift Tape Instructions
Professional Certification Institute
LIFT TAPE SAMPLING CHAIN OF CUSTODY
Form
This lift tape sampling chain of
custody is a mold laboratory form that is completed bythe Professional Certification Institute,
National Highway, Botong,
Lumbangan, Mabinay 6207, Negros Oriental, Philippines.
Please print the requested information below with a black ink p the tester (property
owner, manager, or
agent or employee thereof), who collects the lift tape samples and records
the details of each sampling on this form. This form also serves to document
both the transfer of custody of the lift tape samplings directly from the
tester to the mold lab, and their receipt
by the lab. Please mail (airmail or postal global priority mail) the lift
tape samples and this completed Chain of Custody form to
en neatly and legibly.
Tester’s name
________________________________________________________________________________________
Client name
___________________________________________________________________________________________
Client mailing
address:_________________________________________________________________________________
_____________________________________________________________________________________________________
Client Daytime Phone: (________) ___________________________ Client FAX
(________)________________________
Client Email:______________________________________________________ Date of
sampling____________________
Sampling
address______________________________________________________________________________________
______________________________________________________________________________________________________
Type of laboratory mold analysis to be performed:
____ mold verification & quantification (US$149 for each group of 10 lift
tape samples).
____ mold verification, quantification, & mold species identification
(US$224 for each group of 10 lift tape samples).
|
Sample Number
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Specific Lift Tape
Sampling Location |
Room
Width |
Room
Length |
Notes |
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