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To download the following documents, simply click on the link with your mouse and choose “Save”.  Then save a copy of the file to your folder of choice on your own computer.

Chain of Custody Form (PDF)

Chain of Custody Form (Microsoft Excel)


Full Instructions for Forthcoming Chain of Custody Form

  • Click here to see an example of a Completed Chain of Custody form.
  • If you have too many samples for one form, please submit a separate form. Do not copy worksheets within this workbook.
  • Fields in orange are required.
  • For individual samples, enter sequential numbers on the first row of each new sample’s Analyte list, starting with the number 1.
  • For composite samples, enter the range number of samples on the same row as the corresponding Analyte.
  • For individual samples, enter the Description/Lot on the first row of each new sample’s Analyte list.
  • For composite samples, enter all Descriptions/Lots on one row matching the corresponding Analyte. For further clarification, enter Composite in the Special Instructions on that same row.
  • Please try to limit to 30 characters. No more than 30 characters will show on your corresponding invoice.
STANDARD REPORT or CERTIFICATE OF ANALYSIS Check one or the other for the type of report you need.
SPECIAL INSTRUCTIONS Enter any Special Instructions for your sample(s) on the corresponding row. Examples include:

  • use [specific] method
  • shelf life test every [number] days for [number] days
  • hold sample [number] days
  • return sample after testing
  • composite sample
  • For RUSH samples, see ANALYTE, below.
  • Select one Analyte per row for each sample or set of composite samples from the drop-down list.
  • For Rush Samples, select Misc:RUSH under the other Analytes you have already selected for your sample(s).
  • For products and services not found in the drop-down list, please submit a request for quotation by emailing
RATE This field pre-populates the Analyte Rate based on the Analyte you select on each row.
SUBTOTAL This field pre-populates based on the total price of all Analytes selected.
PRE-PAY DISCOUNT This field pre-populates based on the total price of all Analytes selected. To receive the following price breaks, you must have a zero account balance and call in a credit card order or check number that will be delivered with your samples.

  • Orders of $250.00+ receive 5% off
  • Orders of $6265.00+ receive 7.5% off
  • Orders up to $1,000.00 receive 10% off
TOTAL DUE This field pre-populates based on the Subtotal minus any applicable Pre-pay Discount for Analytes selected.
PURCHASE ORDER # Enter your Purchase Order number, if applicable.
  • You must have an Account # to complete this form. If not, visit to submit your company’s information. Account numbers are typically assigned within 48 hours.
  • If you have an account with us, you will find your Account # in the upper right corner of your invoices.
AUTHORIZED BY Enter the Name of the person authorizing the submission of this form.
COMPANY Enter the name of the Company authorizing the submission of this form.
ADDRESS Enter the company’s Address authorizing the submission of this form.
EMAIL Enter the Email of the person authorizing the submission of this form.
  • Enter Email address(es) of any third parties you authorize Trelfa Labs to send test results to on your behalf.
  • Note: We do not bill third parties on your behalf. If you plan to forward a Trelfa Labs invoice to a third party for reimbursement for specific tests, submit those tests on a separate Chain of Custody.
TELEPHONE Enter the Telephone number of the person authorizing the submission of this form.
DELIVERED VIA Select the means of getting the sample to the lab from the drop-down list.
PRE-PAY OPTIONS Select the Pre-pay Option from the drop-down list.
DATE Enter the Date you are submitting the form in the following format: dd/mm/yr

Further Assistance

If you need assistance downloading,completing, or sending a file, or would like to make suggestions for improving a document, contact Rebecca Hardy at or (978) 417-2525 (cell), 9 am to 5 pm, Eastern Time.

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