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_ Hisloficol <br /> P. . Analysis Rcquest/Choin of Custody <br /> a <br /> Lancaster Lab01'"ws 0959 For LancasterLaboratoriesuse only <br /> l�qt tyisasrrerr . Acct.M q ) Group# f 1�v t`t Sample#:6 3 >39 a - 1 (0 <br /> Please print Analyses Requested SCR#: <br /> Site/Global ID: Preservation Codes Preservative Codes <br /> Site Address: Z l 0 E3j� P4 ti C H=HCI T=Thiosulfate <br /> OYIN=HNO3 B=NaOH <br /> ChevronTexaco PM:M.Scott Mansh t Lead Consul t:SAI c S=H2SO4 O=Other <br /> � <br /> 4 .� �a q W7 SO& LOS- v <br /> ConsultanUOffice:-]�u1'"` � ❑J value reporting needed <br /> Fa <br /> ❑3800 Watt Avenue,Suite 210,Sacramento,CA 95821 ❑ - W44PP Risk Assessment Detection <br /> 0 Limits <br /> Consultant Prj.Mgr.: ❑ J a <br /> ❑ <br /> ii{ LL O N Chromatograms <br /> Consultant Phone#: LV Fax#: ' 7 0 � 2 U I <br /> ,�c� <br /> q .0 6 <br /> Sampler: jot A C ail,-& — 4 �� L�C_k 1 t r r'i',f��l � I= ie 0 <br /> o � � <br /> N o � <br /> Q Z <br /> co O <br /> co <br /> Field Repeat Top Time New OE o o w = a <br /> Point Name Matrix Sample Depth Year Month Day Collected Field Pt YIN i? U m a <br /> t 9 Comments t Remarks <br /> '-56-30 <br /> --3 - 0 1 <br /> 3J) <br /> --3 D !� <br /> Turnaround Time Requested (TAT)(check box) Relinquished by: D to Time Received by: Date Time <br /> STD. TAT ❑ 24 hour ❑48 hour <br /> ❑ 5 day ❑ 72 hour ❑4 day Rel n wished by: ate Time Received by: Date Time. <br /> Matrix Values Repeat Values Relinquished by: Date Time Received by: Date Time <br /> S Soil D Duplicate sample Relinquish rcial Carrier: Received by: Date Time <br /> W Surface Water or Groundwater T Triplicate Sample <br /> T Trip Blank-QA Sample N Pre-Purge Sample UPS FedEx Other Il/k! 9�S <br /> R Rinsate Blank-QA Sample P Post-Purge Sample <br /> M Miscellaneous(e.g.,product sample) Temperature/pH Upon Receipt - Co pH Custody&als Intact? Y s 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 />