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tConcourse Drive <br /> Inchca a Testing Services Suite E <br /> San <br /> Jose,CA 95151 <br /> Anametrix Laboratories Fax 408-452-8194 <br /> L.. Fax408-452-8192 <br /> CORRECTIVE ACTION FORM <br /> Sample Receiving / <br /> Sample Custodian: Date: C/ S6 Z. <br /> fi�Vorkorder Number: / ����� Proj. ID/SDG: , <br /> SAMPLE CHAIN OF CUSTODY <br /> Containers with headspace _ Not received <br /> _ Containers without labels _ Illegible <br /> _ Improper containers _ Containers do not match <br /> Containers broken _ Incomplete <br /> _ Not properly preserved <br /> Transferred upon receipt <br /> _ Cooler temperature outside of range: NO CORRECTIVE ACTION REQUIRED <br /> _ Arrived outside of hold time for <br /> METHOD(S) <br /> V <br /> _ Other(please specify): <br /> t. <br /> r <br /> .Affected Samples(s): <br /> v <br /> ,.orrective Action: <br /> V <br /> Ir <br /> supervisor Ve Date: <br /> ')A/QC: Date: <br /> V <br /> 003 <br /> crdfavn✓uall/11895 <br />