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STL Los Angeles <br /> Condition Upon Receipt Anomaly Report (CUR) <br /> Client, Date/Tune <br /> Lot No- ,4 Initiated by: � <br /> Affected samples Cbain of Custody <br /> Client ID Lab ID Analyses Requested <br /> CONDITIONIA.,iOMALYfVARIANCE(CHECK ALL THAT APPLY): <br /> a COOLERS 0 CUSTODY SEALS (COO LER(S)ICONTALYER(S) <br /> R Not Received,No(COC) O None <br /> ❑Not Received but COC(s)Avallable O Not Intact <br /> 0 Leaking 0 Other <br /> 0 Other: <br /> a CHAIN OF CUSTODY(COC) <br /> TEMPERATURE(SPEC ?20C) 0 Not relinquished by Client;No date/time relinquished <br /> �oolerTemp(s) f 0 Incomplete information provided <br /> Temperature Blank(s) n fie= 0 Other <br /> • CONTAVERS • CONTAINERS LABELS <br /> 0 Leaking ❑Not the sane ID/Info ss In COC <br /> *rolcrn a Incomplete Information <br /> a Extra 0 Preservative <br /> ❑Without Labels 0 Collection Time Date <br /> 0 VOA Vials with$eadspace mm 0 Markingsllafo Illegible <br /> 11 Other 0 Torn <br /> 0 Other <br /> • SAMPLES <br /> C Samples NOT RECEIVED but listed on COC 01Y111 be noted on COC--CUent to send samples with new COC <br /> p Samples received but NOT LISTED an COC 0 MWxbeled as to tests,preservatives,ete, <br /> 0 Logged based on Labd Information 0 Holding time erph ed <br /> 0 Logged based on info from other samples on COC 0 Improper coatalner asW <br /> 0 Logged according to Work Plea 0 Not preserved/improper preservative used <br /> 0 Logged on HOLD UNTIL FURTHER NOTICE 0 Improper pH Lab to preSsrre sample and document <br /> 0 Other 0 Insufflaent quantities for analysis <br /> Comments -•!� C tI r i 0,cc e 3 c',;�O vz cY✓ <br /> �c <br /> Corr=&e Action Implemented: <br /> 0 Client Informed:verbally an By: In writing on By: <br /> 0 Sample(s)p "as ls•" <br /> 0 Sampfe(s)on bold until: _ _ If rdeasrd,notify: <br /> Sample Control Supervisor Review: Date: <br /> rproject Management Review: Date: <br /> SIGNED ORIGINAL MUST BE RETAINED M THE-PROTECT FILE <br /> -- 000004 <br />