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• lifo / / • • a / • • / <br /> 6 <br /> A <br /> For Lancaster Laboratortae use only A <br /> Lancaster Labaratflries Acct # �Sample# lu SCR# N <br /> Where qua4ty�sasaersce <br /> )0102--004 Analyses Requested 2-9 ZZ-5 <br /> 4 <br /> N <br /> Matrix Preservation Codes Preaervatlye Codes <br /> Facility# - N= HCI T=Thiosullate a <br /> Site Address 575 GRANT UNE ROAQ. TRArY, CAa N=HK03 B=Na0H <br /> S =H2504 0=Other <br /> Chevron PM R� _ _Lead C4nsuse r _ <br /> D J value reporting needed , <br /> 13 <br /> ConsultanUQffice ` t3 Must meat tawest detectlon limits n <br /> CL z possibla for 8260 compounds -► <br /> Consultant Prj Mgrm <br /> Fax ❑ o❑ OQ Q 8021 MTBE Confirmiition <br /> Consuitarit Phone g��551_75F5 ` []Confirm hlpheal hltby 6260 <br /> Sampler ❑ [3 Cannan all hits by 8260 <br /> Servlce Order# 0Non SAR � � � Z { ,' E3Run,cxy s on hlghosl hlt <br /> Date Time o 1 o " $ ❑Run _oxy s on all hits <br /> Sam ie Idsnt1 icatlon Collected Collected 07 3: O <br /> I Comments f Remarked <br /> raw- r ass' X 00 Tp#-D OW-u"(r <br /> M W__ <br /> A4W ' 3 <br /> • /}off <br /> to <br /> S 4. <br /> �'— <br /> N <br /> U1 <br /> /- r <br /> MW <br /> 3Z s' <br /> co <br /> /0 2!r x Y, <br /> Relinqulahed b Data Tlme Received by Date Time a <br /> Tumaround Time Requesled (TAT)(please circle) <br /> fi 72 hour 48 hour iriq ie 71me Rec �+ d by c Tlme m <br /> 24 hour 4 day 5 day ! C= <br /> Palln edb Time Received at Time La <br /> Data Package Options(please circle if required) V_V� V67— <br /> A- <br /> 2 <br /> 1) � <br /> f' d c <br /> QC Summary Type I—Full quishad by Co ar a[C carter , Recelved y to Tlme <br /> Type V1(Raw Data) ❑Coett Deliverable not needed UPS FedEx <br /> WIP(RWQCB) <br /> DiskTemperature Upon Recelpl C. Custody Seals tnlact7 es No <br /> 3480 Rev 7130f0 <br /> Lancaster Laboratories,Inc,2425 New Holland Me,PO Box 12428,Lancaster,PA 17605-2426 (717)656-2300 <br /> Copies White and yellow should accompany samples to Lancaste r Laboratories The pink copy should be retalned by the cllent <br />