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rte. <br /> r 0MV,FAN , r - • - • • • <br /> Lancac <br /> ster Laboratories For Lancaster Laboratories use only <br /> 1 Wtwegjalityt isascience. Acct-#: Sample#: <br /> SCR#: <br /> Analyses Requested <br /> Facility Preservation Codes Preservative Codes <br /> y <br /> Site Address: J? -��1'VY • ✓1 �z. �(1}r'y 0pt, F! - HCI <br /> - . _ a -. T <br /> _ =Thiosulfate... <br /> N = HNO3 B=NaOH <br /> Chevron PM: . Lead Consultant: Q('d_?/" v 5= H2SO4 O=Other <br /> n V <br /> Consultant/Office: 11-1 0 - Ed S4.0 ionF.,,rc� m <br /> V S ❑ c7 ❑J value reporting needed <br /> �� L1Gt✓a ©c o Must meet lowest detection limits <br /> Consultant Pd. Mgr.: o ,} <br /> Consultant Phone#: l C Y (6 f- [��(00 Fax#: ��I O�/3(� o o ❑ El <br /> possibke for 8260 compounds <br /> Ce 0 <br /> S>�pr/E )_ i°, co a 8021 MTBEGonfirmation <br /> Sampler: - - U wt15cv--] Q Q Q <br /> ❑Confirm highest hit by 8260 <br /> m F m o o G ❑ <br /> Service Order#: ❑Non SAR: rra M �, ❑Confirm all hits by 8260 <br /> CL Field Repeat Top Time New E :4 x Run_oxy's on highest hit <br /> Pain Name Matrix Sam le Depth Year Month Da Collected Field Pt. C9 ci J xy's on all hits <br /> ❑Run_o <br /> Pr� w v Lf 117 e1-fy v (� <br /> YLt f„j_ ©, lam, Comments!Remarks <br /> � v � <br /> Turnaround Time Requested (TAT)(please circle) Relin ' ishe Date Time Received by: <br /> Date Time <br /> TD.TAT 72 hour 48 hour !d-L i uT cx] <br /> 24 hour 4 day 5 day Rel quis ed Date Time Received by: <br /> Date Time <br /> Data Package Options(please circle if required) Relinquished by: Date Time Received by: <br /> QC Summary jNo <br /> ate Time <br /> � Type I-Full <br /> Type Vl(Raw Data) ❑Coelt Deliverable not needed Relinquished by Commercial Carrier: Received by: <br /> WIP(RWQCB) UPS FedEx Other te Time <br /> Disk Temperature Upon ReceiptCo <br /> G Custody Seals Intact? Ye <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 />