Chain of Custody for Sending Samples to G.B. Byrnes Consulting, Inc.

3004 Teague Rd, Houston, TX 77080 · Phone: 713-460-4130 · Fax:713-460-4011 · www.coatingsfailures.com


Client Information
Contact Name . Email .
Company Name .
Address .
Phone . Fax .


Project Information
Project Name: . P.O. #: .
Reporting Instructions: .
Disposal Instructions: .
Disposal 10 days after project end unless instructed otherwise.

Sample Information
Sample ID Sample Description Collection Date Remarks
. . . .
. . . .
. . . .
. . . .
. . . .

Testing Information:
Turnaround Time (circle one): Regular Rush PANIC Specific Date
Note: Not all turnaround times may be possible and additional charges may apply.
Analysis Required (circle one): Failure Analysis FT-IR ID Overspray Analysis Other
Details on Analysis:  .
.

Submission Information
Submitted by: . on . (signed) .
Received by: . on . (signed) .
Sent via: . Tracking # . © 2006 | Custody continued internally