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i I <br /> 's Requestllv..hain of Custody <br /> /� Q <br /> For La s Laboratod s use only V'[y�-ma y" /,iU15I� <br /> ��.�di'lCwter iti.Q1JVl dLtJt�W gcat # _ Sample# Q —SCR# <br /> t�i111ls's°t�ltyi;5asoerx� r - � <br /> Anatyses Requested ' <br /> Facility# Matrix Pr servation Codesi Preservative Codes <br /> H:2 HCI T=Thlosulfate <br /> Site Add <br /> !N-=HNOa B=NaOH <br /> IS=H2SO4 O=Other <br /> Chevron Ply Lead Consults <br /> a - „ m �' _ ❑J value ieportin9 needed <br /> Consultant/OificoxR, Inc, 6747 Sieri s Court, Suite J Dublin,Ce 945fi8 n ` p^ p Must meet lowest detection hinds <br /> CL <br /> .9 possible for 8260 Compounds <br /> Consultant Pq MgDsanna L Herding fdeanna@alin9;,trorr9l �' ° U 0 '0 a; - <br /> Fax '� ISrSi_7RQ0 �I _ ❑ n a12 <br /> 8021 MTBE Confirmation <br /> Consultant Phone#25,5,51.7554 � 4 � °� <br /> o p Confirm highest hit by 8260 <br /> Sampler A K F01 <br /> 0 t i �� m E w g ❑ ❑Confirm all hits by 8260 <br /> Service Order# IN SAO a Z WE 11 axy s on highest hit <br /> N Date Time Lo g o p o r t $ [IRun oxy s on all hits <br /> Sample Identification Collected Collectedm �- J <br /> i� 31•oS' ,r :Comtmetrts 1 Remarks <br /> it ,r-PV bOkt'6 ayrive <br /> —1 ` btvl;�n -Far W-J Z lard <br /> S U 13 1, 1 l mv-4, ano blt-b r <br /> Cm6Uyze *�r Deb, <br /> w- L3 <br /> 1 <br /> w- � i <br /> u 10 <br /> Relinquished by Date Time Reoerved by ; Date Time <br /> Tu�TA <br /> and Time Requested(TAT)(please circle) <br /> n <br /> S 72 hour 48 hour ReG ished by Pao Time R tv by f - g8te Time <br /> 4 day 5 day <br /> Data Package Options(please curie It required) R of I Isi�ed Time Reserved!hF / t Time <br /> Summery Type Full <br /> AexC <br /> Relinquished by Commercial Carrie R by f! Date Time- <br /> Type VI(flaw Data) ©CoeIt lt Deliverable not needed - _ <br /> MP(RWGGB) _ U109-77–Fedex- er ` <br /> Disk - i Temperature Upon Receipt – C' Custody Seals Int ' Yee No <br /> �l 3460 Rev 7130101 <br /> Lancaster Laboratories,Inc,2425 New holland Pike,PO Box 92425,Lancaster,PA 176052425 (717)ti56-2301} ' <br /> • Copies White and yellow should accompany samples to Lancaster Laboratories The pink copy should be retained by the client , <br /> a <br />