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� 1 C <br /> For Lancaster Laboratories uss only J. <br /> Lancaster oratories Moet Sample l! !.I n9an1 ff-�t <br /> i Where r' rsasceerac� <br /> Analyses Requested <br /> Q Matrix Preser vatlon Codes Preservative CcdeB, <br /> Facility a - 7 ©- OS 010"a }, �, t =HCI T=Thiosvlfate <br /> 341 W 7 LELN., LOM, 1 t N=HNO3 t3=NaOH <br /> Site Address SECORRH S=H2SO4 O=other <br /> Chevron PM RC Lead Consultant. a <br /> . nc.. terra Court. Salle u tri a o 1 ❑ Must meet rawest detection rmrts <br /> Consultantfolgce o a 'a � � lbte for 8260 cam <br /> senna ring earina grtnt:cant o z m <br /> Consultant Prl Mgr. ❑❑ o ❑ ❑ ` 8025 MT6E Cflnthrnahon <br /> Consultant Phone# 925-55 -75*�S Fax 92&551-7899 o g 5 & ; K <br /> —{ / � � � � � C]Confirm hrgtrast nn by 8200 � <br /> Sa ter _ l j f IC r. ar.� E m $ $ _ ❑ ❑Confirm all tilts by 626D <br /> Nen SAR u 4 z �' ❑Run—axy s on highest hit <br /> Servrce Order# ❑ a n m ❑ <br /> Dale Tome x z ,� p Run—nxy a on an hits <br /> Sam le Identification Collected Collecled <br /> �/1 7 r i 4, r ` Comments 1 Remarks <br /> d tel! <br /> e.� <br /> - i C f l ti k C [a� <br /> tielrn ad bio, D to Tama eco ad Date (Tome <br /> Tttrnaround Time Requested(TAT)(please circle) ���` 7�r� =� 4 r__ hip <br /> Date Time <br /> I {--- STOti�AT 72 hour 46 hour y Data T[m Received by { <br /> 24 hoar 4 day 5 day a�3aja• <br /> M <br /> Relinquished by Dale Time Recalvad by Date Time <br /> Data Package Options(ptease dile It requtrecil <br /> OC Summary Type t--FullDate Time <br /> TyW Yl jl mw Data) ❑Coro Delrverabla not nosded Relinquishedvrshad by Commercraf Cerner, Received by <br /> Y4IIP(H1Nt]Cfll UPS FedEx Other <br /> t <br /> � <br /> Mk Temporatum Upon"Ovelpt C. Custody Seals Intact? Yes No <br /> Lancaster Laboratories,Inc..2425 Nevi Holland Me,PO Box 52425,Lancasier,PA 57645-2425 (717)656 2304 3460 Rev 7raet0 <br /> Copes,White and yallow should accompany samples to Lancaster Laboraloms The pink copy should be talafned by the diem <br />