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Histodcal Pipeline • 1 • Analysis • • ofCustody <br /> Lwaster Lkw&des 12 3 7For Lancaster Laboratories use only <br /> r i ` f <br /> Wxyeq�uafityisas� 33 j � f' 30 _3 Acct.#: l 1 -S Group# l opsgog Samp a#: 5s f s('001 <br /> Please print 1 f�� Analyses Requested SCR#: <br /> Site/Global!D: —ft lrs 1�.V) S2 �r Preservation Codes Preservative Codes <br /> Site Address: 1�'G7.C U052 ugh &N* f k H=HCl T=Thiosulfate <br /> �.°b N=HNO3 B= NaOH <br /> ChevronTexaco PM:M.Scott Mansholt Lead Consultant:SAIC S=H2SO4 O=Other <br /> ` C <br /> ConsultantlOffios: ❑401 Alberto Way,Suite B,Los Gatos,CA 950320 ❑J value reporting needed <br /> M 3 a <br /> IN 3800 Watt Avenue,Suite 210,Sacramento,CA 95821 z <br /> C1 HPP Risk Assessment Defection <br /> �n l o ❑ �' <br /> Limits <br /> Consultant Prj.Mgr.: �P�C Gnt U ❑ ❑ © <br /> J Q U <br /> t1 ! o N N oQoQQ -6U,n <br /> Chromatograms <br /> `rTF Fax M 0 CD �Consultant # o o 2 aE ,Sampler: rrAX WE m m <br /> co N <br /> Field Repeat Top Time New 2 o o w m = = _ _ Lu <br /> Lu <br /> Point Name Matrix Sample Depth Year Month Day Collected Flew R YIN 0 U � m a a i a <br /> -Z75_ r d$-03 -2 [too y K Comments t Remarks <br /> Q- - Its G,- 03- 28 POT f _ x <br /> sg-zl $ 45-03-ur <br /> -1 — 3 or—103 _Z.� 1130 x �( <br /> SR�214 — 5 03 ?-f I FP X <br /> n -03 1S' X l x K <br /> r <br /> Turnaround Time Requested (TAT)(check box) Relinquished by: Date Time e ived atip Time <br /> STD.TAT ❑ 24 hour ❑ 8 ou 4 h r �4 <br /> �[ A&A <br /> ❑ 5 day 1172 hour ❑ 4 daylinquish by' (14- Date Time eceived Date Time <br /> Matrix Values Repeat Values Relinquished by: Date Time Receive Date Time <br /> 5 Soil D Duplicate sample Relinquished by Commercial Carrier: eceived by: Date Time <br /> W Surface Water or Groundwater T Triplicate Sample , <br /> T Trip Blank-QA Sample IN Pre-Purge Sample UPS FedEx Other 6` s <br /> R Rinsate Blank-QA Sample P Post-Purge Sample <br /> M Miscellaneous(e.g.,product sample) TemperaturelpH Upon Receipt 0-Y3-6,C. pH Custod eats Inta Yes No <br /> Lancaster Laboratories,Inc.,2425 New Holland Pike,PO Box 12425,Lancaster,PA 17605-2425 (717]656-2300 4324.01 Rev.1/14105 <br /> Copies:White and yellow should accompany samples to Lancaster Laboratories. The pink copy should be retained by the client. <br />