CHEMTEX 5544 Leopard Street, Corpus Christi, TX 78408

Environmental & Industrial Hygiene Services Phone: (361) 299-9900, Fax: (361) 299-1155
e-mail: chemtexcc@chemtex.org
CHAIN OF CUSTODY RECORD-INDUSTRIAL HYGIENE
ANALYTICAL SERVICES REQUEST
Client: Address: Phone:
Fax:
Attn: Pager:
(if different from above) P. O. #: Project No.: Project Name: Project Location:
BILLING CONTACT/ADDRESS:

Sample Date Sampling Sampling

CHEMTEX # Sample Identification Media Collected Time Volume Requested Parameters
(min) (lit)

Sample(s) Collected By: Expected Turnaround Time

Emergency Rush___ 2-4 hr Rush____ 24 hr Rush___ 48 hr Rush____ 3-5 days____ 5-7 days____
Remarks:

Relinquished By: Date/Time: Received By: Date/Time:

Relinquished By: Date/Time: Received for CHEMTEX By: Date/Time:

Facilities are also available at:

Organic, Metal, Wet Chemical, Biological and 3082 25th Street, Port Arthur, Texas 77642 (409) 983-4575 FAX (409) 982-1522 e-mail: chemtexpa@chemtex.org
PetroChemical Analysis for Multi Media 138 S. Cities Hwy., Sulphur, LA 70663 (337) 626-2121 FAX (337) 626-2126 e-mail: chemtexlc@chemtex.org
Environmental and Industrial Hygiene Samples