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=rr <br /> STL Los Angeles ! <br /> Condition Upon Receipt Anomaly Report (CUR) ' `' <br /> Client: DatelTime <br /> Lot No: Initiated by: Z j/ <br /> Affected samples Chain of Custody# <br /> Client ID Lab ID Analyses Requested <br /> CONDITION/.,uvOMALY/VARIANCE(CHECK ALL THAT APPLY): <br /> o COOLERi <br /> o CUSTODY SEALS (COO LER(S)/CONTAL`fER(S) <br /> ❑Not Received,No(COC) ❑None <br /> ❑Not Received but COC(s)Available ❑Not Intact <br /> ❑Leaking ❑Other <br /> ❑Other. <br /> G CHAIN OF CUSTODY(COC) <br /> ❑Not relinquished by Client;No date/time relinquished <br /> o TEMPER.'.TURE(SPEC �2�0C) <br /> )Kooler Ternp(s) /( • C C3 incomplete information provided <br /> Xemperatt re Blank(s) �,� /l/t^ ❑Other <br /> o CONTAII`MRS o CONTAINERS LABELS <br /> ❑Lig ❑Not the same ID/info as in COC <br /> *roken E3 incomplete Information <br /> C3Extra ❑Preservative <br /> ❑Without Labeis ❑Collection Time Date <br /> ❑VOA Vials with Hendspace mm ❑Markingsanfo illegible <br /> ❑Other. ❑Torn <br /> ❑Other <br /> O SAMPLES <br /> ❑Samples NOT RECEIVED but listed on COC ❑Will be noted on COC--Client to send samples with new COC <br /> ❑Samples received but NOT LISTED on COC ❑Mislabeled as to tests,preservatives,etc <br /> ❑Logged based on Label Information ❑Holding time expired <br /> ❑Logged based on Info from other samples on COC ❑Improper Conder used <br /> ❑Logged according to Worst Pinn ❑Not preserved/Improper press- ntive used <br /> ❑Logged on HOLD UNTIL FURTHER NOTICE ❑Improper pH Lab to preserve sample and document <br /> ❑Other Cl Insufficient quantities for analysis <br /> Comments c3r-t1.C( c, 7 0 64' 3 W�—r -Zez 0J <br /> Corrective Acttou Implemented: <br /> ❑Client Informed:verbnUy on By: In writing o By: <br /> ❑Sample(s) processed"rs Ls" <br /> ❑Sample(s) on bold until: If ���'II0 ' <br /> Sample Control Supervisor Review: Date: <br /> Project MaL2gement Review: Date: <br /> SIGNED ORIGINAL MUST BE RETAINED IN THE-PROJECT FILE <br /> 000n04 <br />