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Client's Name: G
C Client ' s Name:
Condition Upon Receipt Variance Report
St. Louis Laboratory
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Informed verbally on: Bv:
Informed in writin g on: By:
014501
Login No.: / 721-¢
Client. Due: _ 7- `T,f Ime: 0 Y o
Project No: S-50. 2G D Initiated by: o -A J—kh
Shipper/No : -7
ConditionNariance (Check all that apply): y):
RFA/COC Numbers: /7 D C
.. q Sample received b roken/leaking. 8. q Sample ID on container does not match sample ID
2. q Sample received without proper preserva tive. on paperwork. Explain:
•
q Cooler tempera ture not within 4"C _ 2C
Record temperature:
q pH 9. q All coolers on airbiil not received with shipment.
q other: 10. q Other (expla in below):
.. q Sample received in improper container.
j Sample received without proper paperwork. Explain:
5. q Paperwork received without sample.
6. q No sample ID on sample con tainer.
-. q Custody tape dis turbed/brokervmissing.
C No variances were noted
Notes: ,3 -r- ^,l b ^ Z
I^^^ 610
Sample(s) processed "as is".
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sample receipt Cooler Tempera ture upon Receipt.
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/-A CT e^ —/ ^^Q 4 / [Y rl Ss^^^i 3t ^^,
C Sample(s) on hold unt il : If released. no tify
Sample Control Supe rvisor Review: (or designate) Date: ?" ^ 7 —
Project Management Review: ^ Date: 7 —/P -1Y
SL.ADMIN-0004. Reviseo :! '24/95
SIGNED ORIGINAL NR;ST BE RETALNED IN THE PROJECT FILE
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