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1681 Concourse Drive <br /> Inchcape 'Testing Services Suite <br /> San Jose,CA 66151 <br /> Environmental Laboratories <br /> Tel 4oa-4s2-a1se <br /> INCIDENT REPORT <br /> Sample Receiving <br /> ample Custodian - �' ,� 2 _ Date ? -•Lrder Number Prod ID/SDG _, Z�� <br /> ' SAMPLE CHAIN OF CUSTODY <br /> Containers with headspace Not reserved <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 V"'NO CORRECTIVE ACTION REQUIRED <br /> Arrived outside of hold time for <br /> METHOD(S) <br /> _ Other(please specify) <br /> ffected Samples(s): <br /> Fective Action: <br /> sor Verification Date �- <br /> L CT <br /> V <br /> �Manager Verification /� _ .�- - Date - <br /> r2t93 <br />