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RequestlChain of Custody <br /> Vr <br /> +Lancaster Laboratories R For Lancaster Laboratories use only <br /> Acct # Sample# �{7 ���2y SCR# <br /> Where quality rs a science � p <br /> Analyses Requested Q <br /> � S39 3 ) I <br /> Facility# Preservation Codes Preservative Codes <br /> Site Address a��� 5r sk MCAir-1 S�. JO r- ! _ <br /> dH= HCI T� NaOH <br /> Thiosulfate <br /> Chevron PM 6D6 �Zcl-et-- yLead Consultant �CA� S=H2SO4 b=Other <br /> Consultant/Office 3017 5ttL�.�.�►r�tn.r _ 1 ?_ c ❑ c� ❑J value reporting needed <br /> . . <br /> ��++ �� � � ©Must meet lowest defection limits <br /> Consultant Pr3 Mgr a_tar fc. �'1c�'��,/' U 5 possible for 8260 compounds <br /> Consultant Phone# -111 - OV 490 Fax# 0//6 -Z/- 0�10 o W o Si 8021 MTBE Confirmation <br /> ai CD <br /> o Q L1t <br /> AA __ �— y ❑Confirm highest hit by 8260 <br /> Sampler �G.�. L�dlTt - E m 0 0 ❑ ❑Confirm all hits b y 8260 <br /> � a o <br /> Service Order# ❑Nan SAR a U,Z + - o ❑Run_oxy s on highest hit <br /> Field Repeat Top Time New 0 C0 w = = o ❑Run _oxy's on all hits <br /> IL <br /> Point Name Matrix Sample De th Year Month Da Collected Field Pt 0 m °i-' <br /> �30 Comments!Remarks <br /> Relinquis d by Date Time Received by Date Time <br /> Turnaround Time Requested (TAT)(please circle) If"30 43 143 <br /> STD TAT 72 hour our Relinquib Date Time Received by Date Time <br /> 24 hour 4 day 5 day <br /> Relinquished by to Time Received by Date Time <br /> Data Package Options (please circle if required) <br /> QC Summary Type I—Full + <br /> Type V1(Raw Data) ❑Coelt Deliverable not needed Relinquished mercial Carrier R c ved by Dat Time <br /> WIP(RWQCB) <br /> UPS FedEx Other <br /> Disk Temperature Upon Receipt ' Co Custody Sea tact? Ye No <br /> Lancaster Laboratories, Inc,2425 New Holland Pike ox 12425 Lancaster, PA 17605-2425 (717)656-2300 �60 Rev 10/04/01 <br /> Copies White and yellow should accompany samples to Lanc er Laboratories The pink copy should be retained by the client <br />