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- tool Concourse Drive <br /> Inchcape 'R%,sting Services SuiteE <br /> San Jose,CA 95151 <br /> 406-452-8292 <br /> Environmental Laboratories Fax 408-432-8196 <br /> INCIDENT REPORT <br />' Sample Receiving <br /> I e Custodian -- -_ ��v 7 Date �"�-7 <br /> rkorder Number Pro ID/SDG 2101 G d <br />' SAMPLE CHAIN OF CUSTODY <br /> _ Contatners 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 _1;10 CORRECTIVE ACTION REQUIRED <br /> Arrived outside of hold time for <br /> l <br /> METHOD (S) <br /> Other(please specify) <br /> 1 <br /> Ired Samples(s): <br />'rrective Action: <br /> r <br /> sor Verification Date <br />"ject Manager Verification _ , w� Date <br />�arrir�ss <br />