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Page 32 of 33 <br /> ion" <br /> Lire <br /> WORK ORDER #: 10-05- El El E El <br /> 1SAMPLE ANOMALY FORM <br /> SAMPLES - CONTAINERS & LABELS: Comments: <br /> p� <br /> ❑ Sample(s)/Container(s) NOT RECEIVED but listed on COC )t�-g) <br /> ❑ Sample(s)/Container(s) received but NOT LISTED on COC iw Jecls 1P <br /> ❑ Holding time expired— list sample ID(s) and test <br /> ❑ Insufficient quantities for analysis — list test <br /> ❑ Improper container(s) used— list test <br /> ❑ Improper preservative used — list test <br /> ❑ No preservative noted on COC or label — list test & notify lab <br /> ❑ Sample labels illegible— note test/container type <br /> „@Sample label(s) do not match COC — Note in comments <br /> ❑Sample ID <br /> ❑ Date and/or Time Collected <br /> ❑ Project Information <br /> Z# of Container(s) <br /> ❑Analysis <br /> ❑ Sample container(s) compromised - Note in comments <br /> ❑Water present in sample container <br /> ❑ Broken <br /> ❑Without Label(s) <br /> ❑ Air sample container(s) compromised — Note in comments <br /> ❑ Flat <br /> ❑Very low in volume <br /> ❑ Leaking (Not transferred - duplicate bag submitted) <br /> ❑ Leaking (transferred into Calscience Tedlar° Bag*) <br /> ❑ Leaking (transferred into Client's Tedlar° Bag*) <br /> ❑ Other: <br /> HEADSPACE - Containers with Bubble > 6mm or '/4 inch: <br /> Sample# Container • #of Vials Sample# Container ID(s) #of Vials Sample# Container #of Cont. Analysis <br /> ID(s) Received Received ID(s) received <br /> Comments: <br /> *Transferred at Client's request. Initial / Date: '�L 05// /10 <br /> SOP T100_090(01/29/10) <br />