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STL Los Angeles <br />Condition Upon Receipt Anomaly Report (CUR) <br />Client: C Date/Time <br />Lot No: ��%- �Z�/ �� Initiated by: <br />Affected samples <br />Gain of Custody # <br />Client M <br />Lab ID Analyses Requested <br />�O <br />C'a <br />CONDITIONa,140MALY/VARIANCE (CHECK ALL THAT APPLY): <br />• COOLERS <br />C Not Received, No (COC) <br />C Not Received but COC (s) Available <br />C Leaking <br />C Other. <br />• TEMPERATURE (SPECS 4:t 2°C) <br />Q Cooler Temp(s) <br />C Temperature Blanks) <br />• CONTAINERS <br />0 Leaking <br />C Broken <br />C Extra <br />C Without Labels <br />C VOA Vials with Headspace mm <br />C Other. <br />• SAMPLES <br />C Samples NOT RECEIVED but listed on COC <br />C Samples received but NOT LISTED on COC <br />C Logged based on Label Information <br />C Logged based on info from other samples on COC <br />C Logged according to Work Plan <br />C Logged on HOLD UNTIL FURTHER NOTICE <br />C Other <br />Comments <br />• CUSTODY SEALS (COOLF.WS)ICONTAINER(S) <br />Q None <br />C Not Intact <br />Q Other <br />• CHAIN OF CUSTODY (COC) <br />C Not relinquished by Client, No date/time relinquished <br />C Incomplete information provided <br />C Other <br />• CONTAINERS LABELS <br />C Not the same Mftfo as in COC <br />C Incomplete Information <br />C Preservative <br />C Collection Time Date <br />C Markings/lnfo illegible <br />C Torn <br />C Other <br />C Will be noted on COC—CUent to send samples with new COC <br />C Misl0eled as to tests, preservatives, etc. <br />C Holding time expired <br />C Improper container used <br />C Not preserved/Improper preservative used <br />C Improper pH Lab to preserve sample and document <br />C Insufficient quantities for analysis <br />Corrective Action Implemented: <br />C Client Informed: verbally on By: In writing on By: <br />C Sample(s) p "as is." <br />C Sample(s) on hold until: If released, notify: <br />Sample Control Supervisor Review: Date: _ <br />Project Management Review: ,! Date: <br />r � • t t. qtr r :r ' ' • r <br />