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• <br /> (� Lancaster Laboratories For Lancaster Laboratories use only <br /> Acct # Sample# SCR# <br /> Where qualrty15 a science <br /> Analyses Requested <br /> Preservation Codes Preservative Codes <br /> Facility# !lies.+ - H= HCI T=Thiosulfate <br /> Site Address w C. N= HNO3 S=NaOH <br /> S=H2SO4 O=Other <br /> Chevron PM "Y nh /4fclil(an Lead Consultant <br /> ❑ D w ❑J value reporting needed <br /> Consultant/Office ca N ❑Must meet lowest detection limits <br /> C: CD pounds <br /> go (npossible for 82fi0 corm <br /> Consultant Pq Mgr v ❑ <br /> Consultant Phone# <br /> Oa Fax# 'G� o a 8021 MTBE Confirmation <br /> � <br /> o o ❑Confirm highest hit by 8260 <br /> Sampler N m 8 El ❑Confirm all hits by 8260 <br /> Service Order# ❑Non SAR °C Z + o = - ❑Run____oxy's on highest hit <br /> Field Repeat Top Time New a o o w � z ❑Run,�oxy's on all hits <br /> Porn Name Matrix 1SamoLe De th Year Month Da Collected Field Pt (9 U 1-- m � a <br /> Comments!Remarks <br /> 49 <br /> , 6 <br /> i <br /> AV <br /> 4, <br /> Relinquished by Date Time Received by Date Time <br /> Turnaround Time Requested (TAT)(please circle) <br /> TD T 72 hour 48 hour Relinquished by Date Time Received by Date Time <br /> 24 hour 4 day 5 day <br /> Relinquished by Date Time Received by Date Time <br /> Data Package Options(please circle if required) <br /> QC Summary Type I-Full Date Time <br /> Relinquished by Commercial Carrier Received by , <br /> Type VI(Raw Data) ❑Coelt Deliverable not needed <br /> UPS FedEx Other <br /> WIP(RWQCB) <br /> Disk Temperature Upon Receipt C° Custody Seals Intact? Yes No <br /> 3460 Rev 10/04/01 <br /> I_anraatar LnhnratonPa r In <br />