HHC 116 INF, Bldg 5676 Division Rd

1
HHC 1/16 INF, Bldg 5676 Division Rd Fort Swampy,
FL 12345 (111) 555 - 5555
Fort Swampy ASAP Bldg 1234 Fort Swampy, FL 12345
FC 99
W2LVAA
0001
2001 11 26
123-45-6789
IR
A
Blocks 1 through 6 above can be filled in by you
(The UPL) prior to the start of the urinalysis.
Blocks 8 through 10 will be completed when the
soldier approaches the UPL station during the
unit urinalysis. All other blocks on the front
of this form MUST be left blank.
This is an example of a DD Form 2624 Specimen
Custody Document Drug Testing or commonly known
as a 2624 or Chain of Custody Form. Lets fill
out the form - one block at a time.

Left Click the mouse to continue
2
This is the back side of the DD Form 2624, this
is the Chain of Custody. It is imperative that
all transfers of custody (including into and out
of temporary storage) be recorded here. The first
person to sign this form is the UPL. If you
complete the unit urinalysis and immediately
transport the specimens to the IBTC, then you
will not fill out this portion until after the
IBTC checks your specimens.