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r • ' 1 1 Fir " • . t-AuFstody <br /> ! bor&desFor Lancaster Laboratories use only <br /> Woeqlaks asp Acd.P Sample#- SCRN- <br /> • Analyses Requested <br /> Facility P —.9-7-75 Preservation Godes Preservative Codes <br /> Sde Address �`� _ H=HCl T=Throsulfate <br /> W QST' �. ',�M� ��►�1�_ o�[�� A - 0 N=HNO3 B=NaOH <br /> Chevron PM r 1 Fiyb C�G 1 Lead ConsultantS �R S=Hz50a O=Other <br /> V <br /> f[enIVOlIce S0t:_ Xi m !]J value reporting needed <br /> Consu <br /> _ _ govt? �D-�Si,�e. dao- �,�to - - - - - � � <br /> - - - CD <br /> M o R� ❑Must meet lowest detection frn+b <br /> Consultant Pr! Mgr _i3OL3' SDI� V °Q possible for 8260 compounds <br /> �p O D <br /> Consultant Phone#-211 b� '�t- yam?Fax t (T -v43D o � � o � 8021 MTBE Confirmation <br /> Sampler _ C-7 ©Confirm highest hit by 8250 <br /> ' E © ❑Confirm all hits by 8260 <br /> SerAoe Order#- -O Non SAR z <br /> CL + $ z A Q Run oxys on highest hit <br /> Field - _ Repeal Top Time New M o , x x <br /> o +- a a m ❑Run ox <br /> y's on all hits <br /> P e M Sample De Y rMo D Collect lel Pt i9 U ►- M <br /> PA f '0 Commerift f Remarks <br /> Aira3V10-0— �C P K Pkwq- tail $db <br /> 3�°93 L�L <br /> n �xf; <br /> 28 3 } Rhv <br /> � zo a )5`a 7c IYScs oxy <br /> Relinquished by Date Time Received by Date Time <br /> Turnaround Time Requested(TAT)(plena arde) .7-1s Q <br /> TA 72 hour 4a hour Relinquished by Date Time Received by Crate Time <br /> 24 hour 4 day 5 day <br /> Data Package Options(please circle if required) Relinquished by Date Time Received by Date Ts"me <br /> QC Summary Type I-Full <br /> Relinquished by Commercial Camey Received by Data 3'1iflZ <br /> Type VI(Raw Data) ❑Coelt Deliverable not needed UPSedEx Qthef <br /> VAP(RWQCB) <br /> Disk Temperature Upon Receipt C° Custody Seals Intact? Yes Na <br /> Lancaster Laboratorles,Inc.,2425 New Holland Pike,PO Box 12425,Lancaster,PA 17605-2425 (717)656-2300 3460 Rev 10104101 <br /> Copies White and yellow should accompany samples to Lancaster Laborarorrp-q 'iiia—'r— <br />