R7,Sheikh Hamdan, Karam Dubai

Sample Reception/Submission form

Client Name / ID: Date
Project Name/ ID Sample Reference No.

Sample Condition:
Samples Leakage
Sample Label
Sample Preservation
Samples Quantity
Sample Accepted
Sample Rejected
Client Sample ID/Name

Client Samples LOT No./COC No.

No. of
Sample Type Select Samples Sample ID
Macro-benthic Infauna :
Zooplankton:
Phytoplankton:
Other (Specify):

Sample Storage /Condition

Sample Retention Time

Sample Return/Discard Time

Sample Receptionist Signature: Lab Manager Signature