Laserfiche WebLink
Historical Pipeline Pon"folid Analysis <br /> RequestlChainofCustody <br /> +UKXterL&Qftd9_s 1223 For Lancaster Laboratories useonly <br /> tMlere tyasasaer�re Acct.#: I��I� Group# IDd ZZ� Sample#: ���D <br /> Please print Analyses Requested SCR#: <br /> Site/Globat ID: k) MW Se_ C l Preservation Codes Preservative Codes <br /> Site Address: �]�� S�'C 0 �(1 f {'• (`j/I r�� Q H=HCl T=Thiosulfate <br /> N =HNO3 B=NaOH <br /> ChevronTexaco PM:M.Scott Mansholt Lead Consultant:SAIC d S=H2SO4 O=Other <br /> ` U <br /> Consultant/Office: ❑401 Alberto Way,Suite B,Los Gatos,CA 95032 c N <br /> ❑J vafue reporting needed <br /> 300 Watt Avenue,Suite 210,Sacramento,CA 95821 c E3 2E ElHPP Risk Assessment Detection <br /> �`� 0 <br /> Consultant Pq.Mgr.: Je_ W A U ❑ © _ ❑ Lou c' Limits <br /> o �;, r 0 o Z) a ❑Chromatograms <br /> Consultant Phone#: to ff1�" ZL Fax#: C) m U <br /> Sampler: 1 t-L 4,J d` L�J� a; 0 0 Elw 0 0 0 <br /> Q <br /> p = N ,n ,n uo U <br /> Q Z ro m C o w <br /> Field Repeat Top Time New o 0 w m = = = = F <br /> Point Name Matrix Sample Depth Year Month Day Collected Field Pt YM 0101 H m 2 a- <br /> 73-0 3 ZO Z$ X X Comments 1 Remarks <br /> 66 03 20 1 X X NatD 5$-j0^ 11.5 <br /> 20 ! X <br /> '10 — 5 69 63 2 ' ?c x X x <br /> A7j7fLl <br /> S — 5 68 03 2 x <br /> s ft7. g 0 !3 � t x r <br /> S --� 8 0 3 2 [ x 1 <br /> Turnaround Time Requested(TAT)(check box) at Time Received by: Date Time <br /> >STD.TAT El 24 hour ❑48 hour y <br /> TD 5 day ❑72 hour ❑4 day lei quished by: Date Time Received by: Date Time <br /> Matrix Values Relinquished b <br /> Repeat Values Relinqy: Date Time Received b <br /> p Y Date Time <br /> S Soil D Duplicate sample <br /> W Surface Water or Groundwater T Triplicate Sample Refmquished b o merciai Carrier. i RRf eived by: + ate Time <br /> T Trip Slank-QA Sample N Pre-Purge Sample UPS edEx Other f.Q �L Cts `3 '9 q�� <br /> R Rinsate Blank-QA Sample P Post-Purge Sample T <br /> M Miscellaneous(e.g.,product sample) Temperaturelp' on Receipt C. pH Custody Seals Intact? es No <br /> Lancaster Laboratories, Inc.,2425 New Holland Pike,PO Box 12425,Lancaster,PA 17605-2425 (717)656-2300 4324.01 Rev. 1114105 <br /> Copies:White and yellow should accompany samples to Lancaster Laboratories. The pink copy should be retained by the client. <br />