Wastewater Sample Intake Form - Ginkgo Biosecurity

Wastewater Sample Intake Form

Name *First & Last

Email Address *

Organization *School Name, Site, District, etc

Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code *

Country

Collection Method *

Collection Device Number/Name

Sample ID *Type in sample id or scan barcode (example: GKWWAAA00000)

Collection Date *

Collection Time *

Hours

Minutes

Local Time (please use 24 hour clock; ie. 17:00 for 5:00pm)

Was the sample collection successful? *

Sample Collection NotesPlease provide any additional details related to the sample, collection or on why the collection was unsuccessful. Please use N/A if there are no details to report.