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Ship samples to:
Synergy Science Solutions
4290 Bells Ferry Rd
Ste 134-23
Kennesaw, GA 30144
samples@synergysciencesolutions.com
(678) 744-4184
ANALYSIS REQUEST & CHAIN OF CUSTODY RECORD
SAMPLER INFORMATION
SAMPLE INFORMATION
SAMPLE DATE INVENTORY NO. SAMPLE I.D. NO. SAMPLE DESCRIPTION SAMPLE SIZE/UNITS ANALYSIS REQUESTED
CHAIN OF CUSTODY
RELINQUISHED BY: DATE TIME RECEIVED BY: DATE TIME SIGNATURE
METHOD OF SHIPMENT:
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3.
CONDITION OF SHIPMENT UPON RECEIPT:
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Before You Send Samples

Submission of samples under this Chain of Custody indicates acceptance of our Terms & Conditions of Laboratory Services.

Review the terms before shipment so your team has the latest billing, receiving, storage, reporting, and liability information.

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