Form of sample receiption ‫استمارة استالم نموذج لغرض الفحص‬ ‫كلية الهندسة‬-‫جامعة تكريت‬

analysis QMS ISO-17025/2017

Format Qmcotu-4
Department name Civil Engineering Rev. No. 1
Rev. Date 21/11/2022
Sample seriel no. ----/R//1/2022 Date

Scope of test Construction

Sample type (gas, liquid, solid)

Sample quantity

Receiving date ‫تاريخ استالم النموذج‬

Client name
Company/institution name
Client mail address
Client email address (if any)
Client phone number
Sample name (ID)
Test name
Name of a standard test (if the client requires any)
Cost per sample (Iraqi Dinar)
Number of samples
Cost of samples (Iraqi Dinar)*
Serial no. of receipt
*Advanced payment

Recipient name