Chain-of-Custody Documentation

Chain-of-Custody Documentation

Complete this form to document marijuana sample collection, product details, compliance checks, and required signatures for regulatory record-keeping.
Marijuana Facility Information

Provide details about the facility where samples were collected.
Facility Name
Facility Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Facility License Number
Date and Time of Sampling

MonthDayYear
Date
Hour MinutesAM/PM Option
Is this sample for retesting due to an initial test failure?
If samples are for retesting, confirm the product is not on administrative hold (samples on administrative hold cannot be sampled without CRA approval and removal of the hold).
Product Type
Are the products in final form (individually wrapped as intended for sale)?
If labeled with a concentration, specify the intended concentration (e.g., THC/CBD mg/unit)
Total Mass of Source Package (g)
Unique Metrc Package Tag (Source Package)
Total Number of Containers in Source Package
Number of Sample Increments
Number of Containers Sampled
Number of Sample Containers Collected
Photographic documentation of the entire batch prior to sampling

Cancelof
Photographic documentation of the sample taken

Cancelof
Unique Metrc Package Tag (Sample Package)
Total Mass Sampled (g)
Laboratory License Number
Sampler's Name

First NameLast Name
Sampler's Signature
Facility Representative Name(s) Present During Sampling

First NameLast Name
Facility Representative Signature(s)
Has a transfer manifest been created in the Metrc system?
Sampling Procedure ID
Sampling Procedure Revision Date

MonthDayYear
Date
Should be Empty:

Chain-of-Custody Documentation

Marijuana Facility Information