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Histofical Pipeline Poftfid ` 1 RequestlChainofCustody <br /> +L&Kaster Labors CteS 1229 For Lancaster Laboratories use only <br /> trt q dityisast�rtce. Acct.#: Il�1�J Group#_ I�d ZYCZ Sample#: <br /> Please print '1 Analyses Requested SCR#: <br /> : O <br /> Site/Global IDN IA) Q V_oPMe Preservation Codes Preservative Codes <br /> Site Address: Cly I AAC'&rf CO BALI Fd)A..IJ f 4H=HCl T=Thiosulfate <br /> CL <br /> N=HNO3 B= NaOH <br /> ChevronTexaco PM:M.Scott Mansholt Lead Consultant:SAIL m S=H2SO4 O=Other <br /> L U <br /> Consultant/Office: ❑401 Alberto Way,Suite B,Los Gatos,CA 95032 c 0 , <br /> a FH <br /> value reporting needed <br /> 0 Ave nu Soli 210,Sacramento,CA 95821 0 z PP Risk Assessment Detection <br /> Consultant Pry'.Mgr.: v'� t //179 U ❑ ❑ J o imits <br /> Consultant Phone#: �7 CRpFax#: S `o C�� o ❑ hromatograms <br /> p 111 ��w1� �-5�'U G�r��Ccc E o:3 to o 0 0 o U M <br /> Sampler. � w � © m o o � a <br /> 2 z CQ <br /> co u� o m <br /> Field Repeat Top Time New a o co >< m = _ co i <br /> Point Name Matrix Sample Depth Year Month Day Collected Field Pt YIN t7 U F-° m g <br /> OA ns 0'3Z mments 1 Remar s <br /> kb�'� DB o 2 �Situ nth u <br /> ! ,12, — 08 <br /> 40dary <br /> aound Time Requested{TAT){check box) I <br /> by: at Time Received by: Date Time <br /> D.TAT CT 24 hour ❑48 hour d <br /> ❑ 72 hour ❑ 4 day linquished by: Date Time Received by: Date Time <br /> Matrix Values Repeat Values Relinquished by: Date Time Receiv y: Date Time <br /> S Soil D Duplicate sample Relin lshed b Commercial Carrier: <br /> W Surface Water or Groundwater T Triplicate Sample q y Received by: Date Time <br /> T Trip Blank-QA Sample N Pre-Purge Sample UPS FedEx Other 3124 <br /> R Rinsate Blank-QA Sample P Post-Purge Sample { f b, <br /> M Miscellaneous(e.g.,product sample) Temperature/pH Upon Receipt ° 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 />