EP 1110-1-31
31 Aug 01
FORM 6
RISK ASSESSMENT SOIL SAMPLING
Installation
POC
Housing Group
Street Address
Unit No.
City
State
Sample
Results of Lab Analysis
Location
Bare
ID#
(g/g or ppm)
Date of sample collection:
Date shipped to lab:
(Attach a Copy of the Chain-of-Custody Form to this Form. See Lab Report for QA/QC Information.)
NOTES:
Name of Risk Assessor (print)
Certification Number(s)
Signature
Date
Figure B-7: Risk Assessment Soil Sampling Form
B-13
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