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Chevron California Region Analysis RequestlChain of Custody <br /> +Uncaqer W� For La st�r a orrator_ies use onlyVW*equalityaasoerxe Acct.# C� DQ Sample# 1 ��y''(p SCR# <br /> Anatyses Requested <br /> Facility#Zhryli-i 9 ` X26`I/ Matrix Preservation Codes Preservative Codes <br /> 14 1 Site Address 3 r t H=HCI T=Thiosulfate <br /> N=HNO3 B=NaOH <br /> Chevron PM B• t�0��i d H Lead Consultant d 5=H2SO4 O=Other <br /> Consultant/Office 0 d Q p <br /> 120 Z3 <br /> a w c ❑ ❑J value reporting needed <br /> 60_ E3Must meet lowest detection limits <br /> Consultant Pri Mgr w / o in possible for 8260 compounds <br /> Consultant Phone# /�__�6l ' O Yd D Fax# !fid,$�'I'OYid o g 2 � r 8021 MTBE Confirmation <br /> °� N m ❑Confirm highest hit by 8260 <br /> Sampler r > �l� �, ❑ u o 8 <br /> Service Order# [:]Non5-n _ 2 M ❑ ❑Confirm all hits by 8260 <br /> SAR 0 ¢ z La Ln <br /> ` + $ $ ti ©Run_oxy s on highest hit <br /> Date Time o a " o ,-IT ❑Run_oxy s on all hits <br /> Sample Identification Collected Collected a U O m <br /> 7'-`e-.84 \A/ 2MY I j( I Comments!Remarks <br /> I <br /> Relinquished by Date Time Receiv Date Time <br /> Turnaround Time Requested(TAT)(please circle) I a 0 /yyQ S -dz <br /> STD T =Relpd72 hour 48 hourDate Time Received by Date Time <br /> STD <br /> our 4 day 5 day <br /> Data Package Options(please circle If required) Relinquished by Date Time Received by Date Time <br /> QC Summary Type I—Full <br /> Type VI(Raw Data) ❑Coelt Deliverable not needed Relinquished b ergal Comer R i ed by Date Time <br /> WIP(RWQCB) UPS FedEx Other - 7n IZ-b <br /> Disk Temperature Upon Receipt CO Custody Seals Intact? Yes No <br /> Lancaster Laboratories,Inc,2425 New Holland Pike,�x 12425,Lancaster,PA 17605-2425 (71T)656-2300 0 Rev 7/30101 <br /> ' Copies White and yellow should accompany samples to Lant�ll3r Laboratories The pink copy should be retained by the Brent <br />