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y- <br /> Chevron Calitomia Rfror Anawis <br /> Request/Chain of Cu*,�iy <br /> Lai cc qer LaboratoriesFor tine Laboratories use only � ) <br /> Wheregt�alnyisasaance Acott. � � Sample#: � -3�'f SCRs: Q �a C6 <br /> Analyses Requested <br /> Facility#: / rr] S f yJ� Preservation Codes o aHve codes <br /> Site Address:-'� f� ,` H= H T=Thiosulfate <br /> N 33 B=NaOH <br /> Chevron PM: �ead Consultant- -6z—C S=H2SO4 O=Other <br /> 65 <br /> Consultant/Office: _.. 17'1'7 •/A�i1.rpf�sfLf ❑ ❑J value reporting needed <br /> Consultant Prj.Mgr.: o ❑Must meet lowest detection limits <br /> r. c ro . possible for 8260 compounds <br /> ❑ ❑ <br /> Consultant Phone M 9/ 7tg��f..pSl� Fax#.� � o q c, 8021 MTBE Confirmation <br /> / N L7 L3 N <br /> Sampler w ❑Confirm highest hit by 8260 <br /> Service Order#: o : <br /> Confirm <br /> all hits by 6260 <br /> Field T _ 'z ❑Run <br /> Top. Time New E _ axy's on highest hit <br /> Point Name Matrix 5amDle . I]e th Year Month DaV Collected I Fi I I PE c7 v' >° m m J ©Run_oxy's on all hits <br /> r _ <br /> 7 L/O k Comments 1 Remarks <br /> n Time Re uested TA Relin a Time heed by: Time <br /> q ( T)(please circle) oats <br /> STD.TA 72 hour 48 hour Relinq <br /> our 4 day 5 day to Time Received by: Date Tmee <br /> Data Package Options(please circle K required) Relingms ed by: Date Time Received by: Date Time <br /> QC Summary Type I—Full IN <br /> Type V1(Raw Data) ❑Coelt Deliverable not needed Relinquished by Commercial Carrier: Received by: A <br /> o Time <br /> W1P(RWQCB) UPS FedEx Other L r r'�^� 4 <br /> / <br /> Disk Temperature Upon Receipt 31 C° <br /> Custody 5 , cC? Yes No <br /> Lancaster Laboratories,Inc.,2425 New Holland Pace,PO Box 12425,Lancaster,PA 17605-2425 (717)656-2300 3460 Rev. 10/04/01 <br /> Copies:White and yellow should accompany samples to Lancaster Laboratories. The pink copy should be retained by the client. <br />