Corrective Action Notification

This form is used to document issues that may impact or potentially impact data quality, completeness, storage, or reporting.

Section I: (to be completed by initiator)	Initiator:

Issued to:

Date: 01-01-1970

Subject:

Agency:

Reason for Corrective Action Notification (continue on an attachment if needed):

Start Date/Time:

End Date/Time:

Estimated?

Parameter(s) affected:

Expected Completion Date: 02-15-1970
*Up to 45 days from Initiation Date

Supervisor:

Date: 01-01-1970

Section II:	(to be completed by responsible section or organization)

Corrective Action Taken (continue on an attachment if needed):

Action taken by:

Date: 01-01-1970

Resolution (continue on an attachment if needed): *Include changes to prevent recurrence, and any effect on data.

Resolved by:

Date: 01-01-1970

Forward to: PQAO Point of Contact; PO Box 2815, Sacramento, California 95812; QA@arb.ca.gov
For questions regarding the CAN process, contact: QA@arb.ca.gov	CAN # assigned:

California Air Resources Board

MLD/QMS-064 (new)