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

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Initiator. Orlette Johnson Batch: Parameter:
Date: !17 06 Samples: Mat ri x:
Client: t Method: swwerlucnwwicLP/ Prep Batch:
1. Reason for SDR
a. COC Discrepancy _ Tech P rofile Er ror Client Request Sampler Error on C-O-C
Transcription Error _ Wrong Test Code _ Other
b. General Discrepancy
_ Missing SampVEx tract _ Container B ro
ken _ Wrong Sample Pulled _ Label ID's Illegible
Hold Time Exceeded
_ Improper Bottle Type
Insufficient Sample
_ Not Amenable to Ana lysis
Preservation Wrong
X Other
— Received Past Hold
Note: Verified by [Log4n] or [Prep Group] (circle)... signature/date:
c. Problem (Include all relevant specific results; attach data if necessa ry)
On 5110!06 sample storage refrigerator ID# R003 malfunctioned and was not holding the required sample storage
temperatu re of 4°C +/- 2'C
2. Known or Probable Causes(s)
Broken motor
3,. Discussion and P roposed Action Other Description:
_ Re4og At the time of malfunc tion R003 was used for storage of samples received
_ En tire Batch for extractable organics, metals and wet chemist ry (except TOC) analyses.
Following Samples: All samples were removed fr om R003 to another refrigerator on 5/1006.
_ Re Aeach R003 was tagged out on 5/10/06, repaired on 5/12/06, and we have
_ Re-extract certified that R003 Is maintaining the required sample storage temperatu re.
_ Re-digest
Revise EDD
— Change Test Code to
_ Place OnlTake Off Hold (cir cle)
4. Project Manager Instructions ... signature/daw
Concur with Proposed Action
sagree with Proposed Ac ti
on; See Instruction
clude in Case Narrative
Client Conta
Date/Person
_ Add'
Cancel
5. Final Action ... signature/date:
6/^`^^
414110 Other Explana ti _ enfied re-{log][leach][extract][digest][an
Included in Case Narrative
_ Hard Copy COC Revised
Electronic COC Revised
_ EDD Corrections Completed
on:
When Final Action has been recorded, forward original to QA Specialist for distribution and filing.
Route Distribu ti
on of Completed SDR Route Distribu ti
X Initiator
X Lab Manager. I. Daniels
X Project Mgr. Stone/Johnson
Data Management: Stilwell
_ Sample Prep: BeegleNger
on of Completed SDR
_ _ Metals: Welsh
Inorganic: Perrone
_ GC/LC: Kiger
_ MS: Schneider/Daley
— _ Login: Per ry
Admin:
— Other
NM1 05-A-0805
999000905