NATIONAL UNIT FOR ENVIRONMENTAL RESEARCH AND SERVICES

Form No. :
PROJECT No: SRUL01/13
Rev.No. :
Khaldiya Campus, Kuwait university, A-49, 2nd Floor, Building No: KH-33, P.O Box 5969, Safat-13060,
Page __ of __
Tel.: 24983781, 24987867
Website: www.nuers.ku.edu.kw

Email: nuers@ku.edu.kw Instagram: nuers_lab

nuerslab@gmail.com CHAIN OF CUSTODY RECORD Twitter: nuers_lab
Client (Internal / External) Name : Address / Department Email: Phone No: After Analysis Samples to be
Returned Disposed
Note: Please collect your samples within
Principal Investigator's (Internal / External) Name / Signature / Stamp : P.I University ID one week after collecting the results or it
will be disposed.

Client / Principal Investigator's Project Details : CONTAINER TYPE/ FIELD PRESERVATIVE TURN AROUND TIME :

Client Project Name/ No. : (Details)

STANDARD - 30 DAYS

OTHER ____________
ACKNOWLEDGEMENT Plastic
I agree to acknowledge Project No.SRUL01/13 in Annual Reports, Final Reports, Graduate student’s thesis and
generated publications. I also confirm that these analyses are consistent with the objectives of my on-going Glass
research projects / research.
Others_________________
I agree to pay standard charges for analysis done for Non-RA funded projects/samples from outside.
Sample Details REQUESTED ANALYSIS

VISUAL CONTAMINATION(YorN)

BEGINNING DEPTH (CM BGS)

MATRIX (TYPE OF SAMPLE)*

ENDING DEPTH (CM BGS)

SAMPLE ID
Sample

NO. OF CONTAINERS
TIME

SAMPLE HAZARD**
Collection Date
DD/MM/YY (24 Hr clock)
REMARKS

Total number of samples:

Relinquished By : (Name and Phone No.) Date/Time : NUERS Director Date Sample Receipt Log#

Received By : Date/Time :

* Matrix-Soil / Sediment-S, Water-W, Oil-O, Plant-V, Filter-F, Bio-Material-B, **Toxic-T Explosive-E Radioactive-R Flammable-F Non-Hazardous-N
Chemical-C, Soild-SS, Sewage-SW, Food-FD