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STL Los Angeles <br />Condition Upon Receipt Anomaly Report (CUR.) <br />Client: C7 �°� ' DatelTime /-2/O <br />Lot No: t1Z/1 Initiated by: <br />Affected samples <br />Chain of Custody # <br />Client ID <br />Lab ID Analyses Requested <br />Way <br />a, <br />CONDITIot4/A,YOMALY/VARIA�YCE (CHECK ALL THAT APPLY): <br />r] <br />COOLERS <br />G Not Received, No (COC) <br />0 Not Received but COC (s) Available <br />0 Leaking <br />0 Other. <br />• TEMPERATURE (SPECS 4:t Z'C) <br />G Cooler Temp(s) <br />G Temperature Blank(s) <br />• CONTAINM <br />0 Leaking <br />0 Broken <br />Cl Extra <br />0 Without Labels <br />0 VOA Vials with Headspace <br />r1 Other- <br />0 <br />ther <br />• SAMTLES <br />0 Samples NOT RECEIVED but listed on COC <br />0 Samples received but NOT LISTED on COC <br />0 Logged based on Label Information <br />0 Logged based on Info from other samples on COC <br />0 Logged according to Work Pian <br />G Logged on HOLD UNTIL. FURTHER NOTICE <br />0 Other <br />Comments <br />Corrective Action Implemented: <br />• CUSTODY SEALS (COOLER(S)ICONTALYER(S) <br />G None <br />0 Not Intact <br />0 Other <br />• CHAIN OF CUSTODY (COC) <br />0 Not relinquished by Client; No date/time relinquished <br />0 Incomplete information provided <br />0 Other <br />• CONTAINERS LABELS <br />0 Not the same o as in COC <br />0 Incomplete Information <br />0 Preservative <br />0 Collection Time Date <br />0 MarkingstInfo illegible <br />G Torn <br />0 Other <br />0 Will be noted on COC --Client to send samples with new COC <br />0 Mislabeled as to tests, preservatives, etc. <br />0 Holding time expired <br />0 Improper container used <br />0 Not preserved/Improper preservative used <br />0 Improper pH Lab to preserve sample and document <br />0 Insufficient quantities for analysis <br />0 Client Informed: verbally on By: In writing on By: <br />0 Sample(s) processed "as is." <br />0 Sample(s) on bold until: If released, notify: <br />Sample Control Supervisor Review: Date: <br />Project Management Review: Date: <br />SIGNED RIGINAL MUST BE RETAIlYED IN TTHE,PROJECT FILE <br />00000a <br />