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+Larxaster I 0 Q}mow For Lancastey "r3 use only 1 <br /> WFmere q**yi5 a s�ence Acct.# 11�_ Sample#: �t SCR#. <br /> Analyses Requested hqD-?Tz <br /> Facility# �[��j" � _ Preservation Codes Preservative Codes <br /> Site Address: S - lT�"� N (26 CL H=HCI T=Thiosulfate <br /> N=HNO3 8=NaOH <br /> Chevron PM: Lead Consultant S=H2SO4 0=Other <br /> Consultant/Office: —'A 4) ❑ ❑J value reporting needed <br /> m ❑Must meet iawwA detection limits <br /> Consultant Prj. I►Agr.: t a y possible For 8264 compounds <br /> Consultant Phone / Fax# o ❑ a © ❑ 8021 MTBE Confirmation <br /> ` N <br /> Sampler. ZW A4 i uoz _ 2 0 Confirm hest htt b 8260 <br /> Service Order#: []Non SDR: c z' § _9 ©Confrrm alll hits by 8260 <br /> Field Repeat Top Time New o + O Run oxy's on highest hit . <br /> Point N th Year Coll L7 v H � ©Run._o ys on all hits <br /> S� Comments I Remarks <br /> MW 1 - G- I 114s �ti)�-uDE <br /> �� 03 3 33 Mt3 I-BZ4 ter F r <br /> tAbi Ito !AZO <br /> z-3L^ <br /> s ° o � <br /> D- o912- <br /> 0 <br /> a4 z <br /> - ig 493 5` <br /> 03 .3 <br /> Relinquished by mate ��� R Time <br /> Tuaround Time Requested(TAT)(please circle) t� <br /> STD.TAT 72 hour <br /> rn48 hour Relin ul <br /> 4 da 5 da q D to Time Received by:� "DaeTime <br /> Y Y IM" Ifav <br /> JData Package Options(please circle N required) ReHnq Date Time R ived b : Date Tine <br /> QC Summary Type I-Full <br /> Type VI(Raw Data) ❑Coeft Deliverable not needed Relinquished eraal Carrier. R i ed by Date Time.; <br /> WIP(RWQCB) VAIAIL genu� ?d = UPS FedEx Other <br /> Disk �v�n5 �,ice ,�M Temperature Upon Receipt a C° Custody Seals! ? es o <br /> Lancaster Laboratories,Inc.,2425 New Holland Pike, x 12425,Lancaster,PA 17605-2425 17 65fr2 34 v. 10104!+01 <br /> • (7 ) 300 <br /> , Copies:White and yellow should accompany samples to Lan aboratories. The pink copy should be retained by the tient. <br />