SAF-RC-047 100 & 300 Area Component of the ... - Hanford Site

Lionville Laborato ry Sample Discrepancy Repo rt (SDR) SDR #: aarjrZZ?
Initiator: Batch: L Parameter: 06WH
Date: Samples: _ _ Matrix:
Client: Method: wwi Prep Batch:
1. Reason for SDR
a. CDC Discrepancy _ Tech P rofile Er ror Client RequestSampler Er ro r on C-0-C
Transcription Er ro r _ Wrong Test Code _ Other
b. General Discrepancy
_ Missing SampletExtract^ . _ Container B roken _ Wrong Sample Pulled _ Label ID's Illegible
Hold Time Exceeded _ Insufficient Sample _ Preserva ti
on Wrong _ Received Past Hold
_ Improper Bo ttle Type _ Not Amenable to Analysis
Note: Ve rified by [Log-Ini or [Prep Groupl (drde) ... aignatumWate:
c. Problem (Include all relevant specific results; attach data If necessary)
m
4f 5-P6 IV FA" FCi^ntsV Gk l/hfrS
2. Known or Probable Causes(s) ,,,, q, , ,^^ ^ _1 _ 4 _ ^,/^ eye `,
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3. Discussion and Proposed Action Other Description,`^"^v
_ Re-log
_ En ti
re Batch
Following Samples:
Re-leach
Re-extract
_ Re-digest
_ Revise EDD
Change Test Code to
_ Place Onrrake Off Hold (circle)
4. Pp6ject Manager Instructions ... signaturerd
V Concur with P ro posed Action
_ Disagree with P roposed Action; See Instruction
_ Include in Case Narrative
_ Client Contacted:
DatelPerson
_ Add
Cancel
5. Final Action ... signatu re/date:
_WVenilled re-[bg](leach)[e digest][analysisj (
Other Explanation:
ci
"ncluded in Case Narrative
_ Hard Copy CDC Revised
Electronic COC Revised
_ EDD Correc
rcle)
ti
ons Completed
When Final Action has been recorded, forward original to QA Specialist for dist ribution and filing.
Route Distribution of Completed SDR
X Initiator
X Lab General Manager aylor
X P roject Mgr. Ston ohnson
_ Data Management:
_ Sample Prep: BeeglelKger
_
Route Distribution of Completed SDR
— Beegle
_ _ Inorganic: Perrone
GC/LC: Kiger
f MS: Rychl aley
_ Log-in: Perarr
_ _Admin:
Other.
oA- 1 05-A-pep5
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