Mold Growth Lab

www.moldgrowthlab.com

Grow, count, and identify only living mold spores in
 your self-collected surface and air samples worldwide,
 both before and after mold remediation.


Email phil@moldinspector.com

Phone Toll-Free 866-300-1616 cell 480-310-7970

 



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Mold Growth Lab CHAIN OF CUSTODY

form for the Lab Mold Species Identification of Mold Growth

in Surface Samplers, Petri Lab Dishes, & Bulk Samples

This Mold Growth Lab chain of custody form needs to be downloaded and fully completed by the person collecting surface samples, air samples, and bulk samples (such as property owner, manager, resident/occupant, or agent or employee thereof, or mold inspector or environmental hygienist). This form documents both the transfer of custody of the collected samples directly from the sample collector to Mold Growth Lab, and their subsequent receipt by the lab.  Please mail the collected test media, this completed Chain of Custody form, along with your Mold Growth Lab payment receipt, to the lab address provided on the payment receipt.  Please print the requested info below with a black ink pen legibly because the information that you provide will be included in the mold lab report.  
Questions? Contact Phillip Fry, lab manager, by email phil@moldinspector.com,  or phone toll-free 866-300-1616 or Phillip’s cell phone 1-480-310-7970.

Date of sampling: ____________________             Date samples sent to lab:________________________

Property owner name: ____________________________________________________________________

Sampling Property Physical Address:_____________________________________________________________________________________________

__________________________________________________________________________________________________________________________

Collector’s name: __________________________________________      Collector’s Signature:  _____________________________________________ 

Date: ________________________  Daytime phone: (_____________) _______________________________        

Email address:____________________________________________________________________________ 

Type of laboratory mold analysis to be performed by the lab is viable/cultured growth of samples for seven days (mold species identification and count of grown/live mold colonies). This is the best method for accuracy of mold species identification and to determine whether the mold spores are alive or dead, but it takes 7 days of mold culture growth, plus one or two days for mold lab specifies identification analysis.
 

Sample
Number

Precise location description from which the sample was taken

Type of sample: surface sample, air sample,    or bulk samples

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