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t <br /> Laboratories For Lancaster Laboratories use only <br /> +LalLer <br /> 4��Y+sasoerxe Acct # Sample# 5CR# <br /> Analyses Requested <br /> Matrix Preservation Codes Preservative Codes <br /> Facility#nl�oy�znn 4-X1275` H=HCl T=Thiosulfate <br /> Site Address agt)!5' v.A Ant-4-i Me- e,f,-eCLC-0i'l C A- N =HNO3 B=NaOH <br /> Chevron PWjQjQ (,pckcgi.A — Lead Consultant _ a,2_ _° w S=HzSO4 O=Other <br /> �, <br /> 12 ❑,i value reporting needed <br /> Consultant/Office 30�-� i<_,.�1��r� �. ..,6r3 . �✓ c�Cfi o c ❑ <br /> o a 2 $ ❑Must meet lowest detection limits <br /> cc <br /> Consultant Pq Mgr o inP C possible for 8260 compounds <br /> Consultant Phone# ,ci�i_fes!-o Y� Fax# 914-S6I-OSn3c) o g © 8021 MTBE Confirmation <br /> Q m a A, ti [3 Confirm highest hit by 8260 <br /> ❑ <br /> Sampi �,r9 is7�i'iG� m E Lu 0 ❑ ❑Confirm all hits by 8260 <br /> Service Order# ❑Non SAR 0 ¢ Z W� "' - ❑Run_oxy s an highest hit <br /> Date Time o o m 0 o + <br /> ❑Run oxy s on all hits <br /> Sample identification Collected Collected C7 lo r in t- <br /> -7.a 1-10 7 Comments 1 Remarks <br /> -?-d45- XX <br /> .Az <br /> XX X <br /> 0 <br /> Air 1'�-Ia <br /> 441,0-0 &--7-o 0 <br /> Relinquished by Date Time Received by Date Time <br /> Turnaround Time Requested(TAT)(please circle) <br /> TD TA 72 hour 48 hour Relinquished by Date Time Received by Date Time <br /> 24 hour 4 day 5 day 0'�' 7 <br /> Data Package Options(please circle if required) Relinquished by Date Time Received by Date Time <br /> QC Summary Type I—Full <br /> Relinquished by Commercial <br /> Type VI(Raw Data) C1 Coelt Deliverable not needed UPS <br /> Corner Received by Date Time <br /> UPS FedEx Other <br /> WiP{RWQCB} <br /> Disk Temperature Upon Receipt Co 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 7/30/01 <br /> Copies White and yellow should accompany samples to Lancaster Laboratories The pink copy should be retained by the client <br />