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Inchcape fisting Services Suite oawurscDrivc <br /> 1 En�-ironmental La Sao lose,CA 65151 <br /> . Laboratories Tel 468'432-8192 <br /> Fax 408-432-8198 <br /> INCID' +NT REPORT <br /> ' Sample Receiving <br /> ample Custodian � // <br /> Date d '1! f4 <br /> Vorkorder Number 1 O ` y <br /> Prol ID/SDG T57'111- <br />' SAMPLE CHADq OF CUSTODY <br /> Containers with headspace Not received <br /> --,,-C-ontainers without labels Illegible <br /> Improper containers — Containers do not match <br /> Containers broken ` Incomplete <br />' — Not properh presened <br /> Transferred upon receipt <br /> s Cooler temperature outside of ranee _ NO CORRECTIVE ACTION REQUIRED <br /> Arm ed outside of hold time for <br /> METHOD {S} <br /> Other please spectf�) <br /> 1 <br /> fectcd SarrildL% (%) S A <br /> Q w t^ cr—, <br /> orrectne Action Ip <br /> d'r� ►r t <br /> u�sor ��ntic-lllon <br /> ` Date 1 0 I cr IcI S� <br /> Datc <br /> �, 139 <br />