Custody record

Chain of Custody Form

Document sampler, client, sample transfer, custody details, signature, and traceability metadata.

Client and Matching Identifiers

These values support later matching to Confident Cannabis, METRC, sample IDs, and batch records.

Client / Licensee Name *Client Contact Name *Client Contact Email *Client Contact PhoneMETRC License Number *METRC Manifest Number *Confident Cannabis Order NumberBatch / Lot Number

Custody Details

Sampler, collection, and transfer details.

Sampler Name *Sampling Date *Transfer Method *Notes

Samples

Add each sample that belongs to this submission.

Sample 1

Sample ID *Sample NameProduct TypeMatrixBatch / Lot Number *METRC Sample IDMETRC Package TagQuantityQuantity UnitCollection Date / Time

Authorization and Signature

The signer authorizes Prism Triangle to retain the completed private PDF and audit trail.

I consent to Prism Triangle, LLC collecting my IP address, browser/device information, and optional browser-provided location data for identity verification, audit, authenticity, and traceability of this sampler form submission.

Signer Name *Signer Email *Signer Title

Signature