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HistoricalPipeline Poftfid AnalysisRequestlChath. of Custody <br /> +Lw.astff LA � 1233 I [ 2 For Lancaster Laboratories use only C'®p <br /> Wherequ*fSascierm Acct.#: ! `I 3 Group#_ i Q b q Stu Z Sample#: 'S 3 <br /> Please print Analyses Requested SCR#: <br /> Site/Global ID: l' c Preservation Codes Preservative Codes <br /> Site Address: IM01Y� CA Sr' J���, CCWII+r Q H=HCI T=Thiosulfate <br /> N=HNO3 B=NaOH <br /> ChevronTexaco PM:M.Scott Mansholt Lead Consultant:SAIC d 5=H2SO4 O=Other <br /> U <br /> Consultant/Office: C3 401 Alberto Way,Suite B,Los Gatos,CA 95032 _ r i <br /> ❑J value reporting needed <br /> Jq3800 Watt Avenue,Suite 210,Sacramento,CA 95821 <br /> Elm z HPP Risk Assessment Detection <br /> Consultant Pd.Mgr.: ��r / y 0 ❑ ❑ J ❑ 0w Limits <br /> Consultant Phone#: CS O u+0+o �'� Fax#: f. O�qC—7111 � o o � � � � � ❑Chromatograms <br /> y m w C7 U uy <br /> ❑ W 0 0 0 <br /> Sampler: + P/1' �� y CD <br /> o 2 M ¢ <br /> g. Z m � o w <br /> Field Repeat Top Time � S w � m i a _ _ <br /> Point Name Matrix Sample Depth Year Month Day Collected FleMPtYIN 0 U F°- LU <br /> Comments!Remarks <br /> nk o 7 16 o . Y <br /> 5 <br /> OP 03 31 10a Y X <br /> 0 r3a Y K <br /> ot0 of 0I k r x Ic <br /> �— o$ 04 01 0930 K ac <br /> SB -2 — �- &f of [o ff- k k <br /> 12-1 Of 01 'Z20 '?c K <br /> 49 S q ' Od 13'� 1 X x <br /> 2-01 <br /> S r 9 ' ids %4 Q[ 16t )c l k <br /> elf *4 <br /> J Ac, <br /> Turnaround Time Requested(TAT)(check box) Relinquished by: Qatp Time Received by: Date Time <br /> rTD.TAT ❑24 hour ❑48 hour 0t> <br /> 5 day ❑ 72 hour ❑4 da R uished by: ate Tim eceived b <br /> Y Y: Date Time <br /> Matrix Values Repeat Values Relinquished by: Date Time Recey: Date Time <br /> S Soil D Duplicate sample <br /> W Surface Water or Groundwater T Triplicate Sample Relinquishe ercial Carrier: Reived by: Date Time <br /> T Trip Blank-QA Sample N Pre-Purge Sample UPS FedEx Other flip <br /> �ty,65f <br /> R Rlnsate Blank-QA Sample P Post-Purge Sample dr X <br /> M Miscellaneous(e.g.,product sample) Tem peraturelpH Upon Receipt LO-1, Co pH ustody Seals intact? a No <br /> Lancaster Laboratories,Inc.,2425 New Holland Pike,PO Box 12425,Lancaster,PA 17605-2425 (717)856-2300 4324.01 Rev. 1114/05 <br /> Copies:White and yellow should accompany samples to Lancaster Laboratories. The pink copy should be retained by the client. <br />