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Chevron California Region r ! _ • ofCustody <br /> #Larrwtu L"&ries WhereQtefftyisascrerxe . L�)IJaories only <br /> Acd0. Sample SCR#.- (?1/Dwa <br /> 6 2 1 d- b V <br /> Analyses Requested <br /> Facility# Matrix Preservation Codes Preservative Codas <br /> Site Addre$ S W- BENJAMIN Hdt T, Sl=am CA ._ n H=HCI T=ThlosuHate <br /> N=HNO3 8=NaOH <br /> f <br /> Chevron PIP_ Lead Consufta6ECOM -- S=H2SO4 0=Other� <br /> ConsuftantlOffio�rR Inc. 6747 Sie u ite li Ca. $ v, c ❑_ 0 valve reporting needed <br /> Consultant Pd.Ma. � � ❑Must meet lowest deb d m Mdb <br /> Consultant Phone - ❑❑ o 13 ❑ possible for 8260 compaards <br /> 1 Fax-, __,_ `o g o o 8021 MTBE Confirmation <br /> Sampler -- 1� ►_� � ❑ g o ❑Confirm highest hit by 8260 <br /> Service Order#: ❑Non SAR z gn _LO ❑Confirm all hits try 8280 <br /> 0B ❑ + $ S [1 Run—„.oxy a on highest hit <br /> Sam le identification lected Collected 0 C� �i 3. O FLa = °- ❑Run—oxy s on all hits <br /> —opt °1�Z1• Comments 1 Remarks <br /> S <br /> $D �L <br /> k1- � <br /> l to <br /> ate <br /> W�IO <br /> 110 <br /> Tum nd Time Requested A Relinquished Da Time .Received by. <br /> q (TAT){pleasecede) - Data Time <br /> 2, . <br /> TAT 72 hour 48 hour Re wished <br /> 24 hour 4 day 5 day by: bete Time <br /> Time <br /> t �# � <br /> Data Package Options(please dr�cle if regained) R u Y= Date Tm►e Received by; Elate Time <br /> OC Summary Type I—F61 ADO <br /> Type VI(Raw Data) ❑CoeB Deliverable not needed Refinqui!oed by Cc rdal Carrier by Tlme <br /> WIP(RWQCB) U �p <br /> Disk Temperakse Upon Receipt C° Custody Seals Intact? No v f <br /> _... Lancaster Laboratories,Inc.,2425 Now Holland Pike,RO Bot 12425,Lancaster,PA 17606.2425 (717)858.2:300 3460 Rev.7130!01 <br /> Copies:White and yellow should accompany samples to Labo atorim The pink copy should be retained by the diets. 0 <br />