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Historical ' _I P• • ! AnalysisRequestlChair, Custody <br /> LSC 1240 [�) For Lan }s r Laboratayries use only <br /> tNtlamq[ tyfSBsvertCt?. Acct.#: 11 Group#f V 3�_�I Sample#: <br /> Please print Analyses Requested SCBM <br /> Site/Global ID: S'► 5{ 1 <br /> 4 fb Preservation Codes Preservative Codes <br /> Site Address: ILMC4 �Ch CY" JOOk y 1A if �,6y1�1 -�, a H=HCI T=Thiosulfate <br /> = N= HNO3 B=NaOH <br /> ChevronTexaco PM:M.Scott Mansholt Lead Consultant:SAIC m S=H2SO4 O=Other <br /> E2 U <br /> Consultant/Office: El 401 Alberto Way,Suite B,Los Gatos,CA 95032 c QJ value reporting needed <br /> .a i3 a <br /> 3800 Watt AVenue,Suite 210,Sacramento,CA 95821 C = z HPP Risk Assessment Detection <br /> �y+ � 1 0 <br /> Consultant Prj.Mgr.: tt' �I^� U ❑ ❑ ? Lu Limits <br /> Consultant Phone#: 513- �� ?y Fax#:PO -W f-7411 ° c> `. ❑ W W ❑Chromatograms <br /> r, L Q) ° m m U' 0 U u� <br /> Sampler: ■ kmi�ez S.1Jd'1 K 0 0 ¢ _ <br /> w o M <br /> p Z m co N <br /> Field Repeat Top Time New S f° x W y m a <br /> Point Name Matrix Sample Depth Year Month Day Collected Fwd Pt 0 L) m ' a 1 F � g <br /> .-- — aQ 03 Z 2'�. l! Comments I Remarks V <br /> �5� �i�s Ccs. �c.� <br /> vg 03 2,C ( <br /> OY 03 gZC 1-71S- 7 CJer.�.L'p � <br /> .` — TSP <br /> Turnaround Time Requested(TAT){check box} Relinquished by: to Time Received by: Date Time <br /> ISTD.TAT El 24 hour El 48 hour ��/��TT� '3uo <br /> ❑ 5 day ❑ 72 hour ❑ 4 day Relinquished by: D Time Received by: Date Time <br /> Matrix Values Repeat Values Relinquished by: Date Time Received by' Date Time <br /> S Soil Duplicate sample Relinquished b ercial Carrier: Receive <br /> W Surface Water or Groundwater T T Triplicate Samples Time <br /> VIN <br /> T Trip Blank-QA Sample N Pre-Purge Sample UPSFedEx Other <br /> R RinsateBlank-0A Sample P Post-Purge Sample <br /> M Miscellaneous(e.g.,product sample) Temperature/pH Upon Receipq_-2L_3,_,7o pH Custody Seals Intact? esj No <br /> Lancaster Laboratories, Inc.,2425 New Holland Pike,PO Box 12425,Lancaster,PA 17605-2425 (717)656-2300 4324.01 Rev. 1194/05 <br /> Copies:White and yellow should accompany samples to Lancaster Laboratories. The pink copy should be retained by the client. <br />