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Lancaster Laboratories Q� For I- caste ones�e only C�77 <br /> IMter2[><►alrtyrsasaertce Acct # � UlLl� Sample# � �����- SCR# (1 �O��i <br /> Analyses Requested <br /> i Facility# <br /> Matrix Preservation Codes Preservative Codes <br /> Site Address �3� C�S1' M Y1 Str>�r: t'rl�_ j H=HCI T=Thao5utfate <br /> N=HNO3 B=NaOH <br /> Chevron PM CA2C�YaAl�- Lead Consultant _ �ECU� 5= 2SO4 O=Other <br /> N U YS S <br /> Consultant/Office S�CaIZ/ 5A cAma=NTv -__— 5 u'o ❑ ❑J value reporting needed <br /> a Z c m ❑Must meet lowest detection limits <br /> Consultant Prj MgrDavid Eva.,-.5 possible for 8260 compounds <br /> U ❑ <br /> Consultant Phone# q 1� '9bf—D(400`"" ax# '31Z fib/-04430 ❑ ❑ o g � o ❑ 8021 MTBE Confirmation <br /> a) coN 0 ❑Confirm highest hit by 82$0 <br /> Sampler S`t�1/eO Irl n s moi^ -- y w 0 0 = <br /> S 2 M m ❑ ❑Confirm all hits by 8260 <br /> Service Order# ❑Non SAR o Q z <br /> CL ❑ + o 0 0 ❑Run_oxy s on highest hit <br /> X CO CO <br /> Date Tlme m 0 o co — o _ CD ❑Run oxy s on all hits <br /> Sample Identification Collected Collected o m "I <br /> �> T"Vo. Comments!Remarks <br /> < D <br /> Relin u by ate Time eceived by bate Time <br /> Turnaround Time Requested (TAT)(please circle) <br /> STD TAT 72 hour 4$hour Relmquis date Time Received by Date Time <br /> our 4 day 5 day <br /> Data Package Options(please circle if required) Relinquished by Date Time Received by Date Time <br /> QC Summary Type I—Full <br /> Type VI(Raw Data) r-1Coelt Deliverable not needed ReIinquishe Co ercial Carrier ceived by A3 T <br /> Exim <br /> WIP(RWQCB) UPS FedOther '��-�;J1 <br /> Disk Temperature Upon Receipt co Custody als intact LYes) No <br /> Lancaster Laboratories,Inc,2425 New Holland Pike,PO Box 12425 Lancaster PA 17605-2425 (717)656-2300 3460 Rev 7130101 <br /> Copies White and yellow should accompany samples to Lancaster Laboratories The pink copy should be retained by the client <br />