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+Lancaster Laboratories For Lancaster Laboratories use only <br /> MerequaUf (5a5caerxe Acct # Sample# SCR# <br /> Analyses Requested <br /> Facility# x{5775 Matrix Preservation Codes Preservative Codes <br /> I I I I d <br /> H=HCI T=Thiosulfate <br /> Site Address 4.1.lNsskktgkwpf 4,-- 3 4 N=HNO3 B=NaOH <br /> Chevron PM �;Ob L%JGl9syw„ Lead Consultant S=H2SO4 O=Other <br /> Consultant/Office 3 tu c❑ - ` ©J value reporting needed <br /> o n :° N F3 ti �, ❑Must meet lowest detection limb <br /> Consultant Pri Mgr [L Z o possible for 8260 compounds <br /> Consultant Phone# Fax#�.!��_�(Q[-O it3� o g 0 8021 MTBE Confirmation <br /> Sampler — ❑ w o v D Confirm highest hit by 8260 <br /> y L a m v © ❑Confirm all hits by 8260 <br /> Service Order# L ¢ z _ <br /> ❑Non SAR CL + o c o ❑Run oxy s on highest hit <br /> ca Date Time o o '0 o u m ❑Run_axy s on all hits <br /> Sample Identification Collected Collected rn O ►— m m <br /> Comments I Remarks <br /> �v r <br /> Relinquished by Date Time Received by Date Time <br /> Turnaround Time Requested(TAT)(please circle) <br /> STD T 72 hour 48 hour Relinquished by Date Time Received by Date Time <br /> 24 hour 4 day 5 day <br /> Relinquished by Date Time Received by Date Time <br /> Data Package Options(please aisle d required) <br /> QC Summary Type I—Full <br /> Type VI(Raw Data) ❑Coelt Deliverable not needed Relinquished by Commercial Corner Received by Date Time <br /> WIP(RWQC13) UPS FedEx Other <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)656-2100 3460 Rev 7130101 <br />