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1961 Concourse Drne <br /> hichcape Tinting Services Suite <br /> SanJose. CA 95131 <br /> Enmlronmental Laboratories Tel 408-432-8192 <br /> Faz 408-432-8198 <br /> INCIDENT REPORT <br /> Sample Recen ing <br /> In ple Custodians �L 1 t, CCL ._ _ Date <br /> A orkorder Number 't {� F (� t 3�,� Proj ID/SDG -t <br /> SAl'1IPLE CRAM OF CUSTODY <br /> Containers-with headspace _ Not recei%ed <br /> Containers without labels _ Illegible <br /> T Improper containers _ Containers do not match <br /> Containers broken _ Incomplete <br /> Not properl% presern ed <br /> 1 Transferred upon receipt , <br /> Cooler temperature outside of range NO CORRECTIN E ACTIO\ REQL IRED <br /> A mN ed outside of hold time for <br /> METHOD (S) <br /> VOther please speclfN) <br /> I <br /> etcd S.lmtilc. (�) <br /> irectne action <br /> isor %erlficmon Date tell, /1114 <br /> %I in icer % .ride u,on Date <br />