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• • ! • <br /> Lancaster Laboratories For Lancaster Laboratories use only <br /> tt <br /> Wheregwyt isaxrence. Acct.#: Sample#: SCR#: <br /> Analyses Requested <br /> Facility#: L1 Preservation Codes Preservative Codes <br /> �l l ., :1 E H = HC1 T=Thiosu(fate <br /> Site Address: .�-� � �" <br /> ' I C "� LeadConsultant: <br /> `N` HNO3 ,.. B= Na <br /> :. <br /> Chevron PM: .1.,.(, UL f ] Consultant. _C. [. S= H2SO4 O=Other t <br /> Consultant/Office: r� 'jC i-- © El value reporting needed <br /> Consultant P0. Mgr.: i�' �` �- r!!"i c ,_ " ❑Must meet lowest detection limits <br /> _—� oo <br /> U j- possible for 8260 compounds <br /> Consultant Phone# L{I(L� `f Fax#:l I j,: [`�!1 �.. El <br /> �` o W o <br /> J 8021 MTBE Confirmation <br /> Sampler: ( •f 1 W a �— ❑Confirm highest hit by 8260 <br /> Service Order* C° El Non SAR: o z �, a o ❑Confirm all hits by 8260 <br /> Field p p Time New m E CL + � ❑Run_oxy's on highest hit <br /> Re eat To + co ti <br /> uJ <br /> Poin Name Matrix am le De th Year Month Da Collected Field Pt. ti l_- ) ❑Run_oxy's on all hits <br /> Comments 1 Remarks <br /> ILI I I I <br /> Relinquished by: _ D e Time Received by: Date Time <br /> ATDTA <br /> and Time Requested(TAT)(please circle) - <br /> 72 hour 48 hour R uished b <br /> 24 hour 4 day 5 day Y, _ Data Time Received by: Date Time <br /> Data Package Options (please circle if required) Felinquishd by: Date Time Received by: Date Time <br /> QC Summary Type I—l=ull <br /> Type Vi(Raw Data) CCoelt Deliverable not needed Relinquished by Commercial Carrier: Received by: Date Time <br /> WIP(RWQCB) UPS FedEx Other <br /> Disk Temperature Upon Receipt Co <br /> Custody Seals Intact? Yes No <br /> Lancaster Laboratories, Inc.,2425 New Holland Pike, 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 />