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Condition Upon Re ce
ipt Variance Repo rt
St. Louis Laboratory
Client. r`i ^}6 Date:
Login No.:
7
? — 1 / " U Time:
Project No: Initiated by:
Shipper/No: 9 3 5 2 2- 1 1 RFA/COC Numbers: ^^^/[/ 7
ConditionNari ce (Check all that apply):
L q Sample received broken/leaking. S. q Sample 0) on container does not match sample ID
3. q Sample received without proper prese rv ative. on paperwork. Explain:
q Cooler tempera ture not within 4°C --- ?•C
Record tempera ture:
q pH 9. q All coolers on airbill not received with shipment.
q other. 10. q Other (explain below)
3. q Sample received in improper container.
4. q Sample received without proper paperwork. Explain:
5. q Paperwork received without sample.
6. q No sample ID on sample container.
7. q Custody tape dis turbed/broken/missing.
—@'- No variances were noted during sample receipt. Cooler Temperature Upon Receipt: yr^-
Notes:
Corrective .action:
q Client's Name: Informed verbally on: By:
q Client's Name: Informed in writin g on: BV:
q Sample(s) processed 'as is".
q Sample(s) on hold until: f released. noufv:
\
-7 g I,
Sample Control Supe rv isor Review: or desi gnate) I cc : 37 — [ / _
Project Mana gement Review: 7\ t—L—
SL-ADMIN-0003. Revised :1!'_4/95
q
Date: 3 — ^ I --v
SIGNED ORIGINAL MUST BE RETAINED IN THE PROJECT FILE