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Q'Auanterra 014501
Condition Upon Receipt Variance Report
St. Louis Laboratory
Client: t/GC'^ Date: 3 — 7 , `!
Project No: 5250 -2(G 6 Initiated by: o-. A-Pi
Shipper/No: RF VCOC Numbers: /7 0 C sL
Condition/Variance (Check all that apply):
'1
Login No.: / 72-2-/
I. q Sample received broken/leaking. 8. q $am pie ID on container does not match sample ID
2. q Sample received without proper preservative. onn paperwork. Explain:
q Cooler temperature not within 4-C t 2°C
Record temperature:
q pH 9. q All coolers on an-bill not received with shipment.
q other: 10. q Other (explain below)
3. q Sample received in improper container.
4. g/ Sample received without proper paperwork. Explain:
5. q Paperwork received without sample.
6. q No sample 1D on sample container.
7. q Custody tape disturbed/broken/missing.
^d No variances were noted during sample receipt Cooler Temperature Upon Receipt:
Noes:
Corrective Act on: t
Q^I., (" ?3) t II !
q Client's [me: Informed verbally on: By:
q Client's Name: Informed in writine on: By
q Sample(s) processed "as is".
q Sample(s) on hold until If released. notify
Sample Control Supervisor Review: (or desi gnate) Date:
Project Management Review: L— " I tN^ Date: J _ (^/ 79
SL-AD?dIN:)004. Revised I1;--1/95
SIGNED ORIGINAL ^',IL'ST BE RETAINED IN THE PROJECT FILE
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