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Historical Pipeline ' • • RequestlChainof <br /> r�C � <br /> ��r L��ies 2220 <br /> ]/� 1 For Lancaster Laboratories use only l ~� <br /> ilM ftysaStB6xe 2`2 O Acct.#: I Group#� VM 2 Sample#.?r�t I <br /> Please print Analyses Requested SCR* <br /> SitelGlobal 1D: Preservation Codes Preservative Codes <br /> Site Address: 17 I qt'0 HWnr61n kZ&i, CA H=HCl T=Thiosulfate <br /> N=HNO3 B=NaOH <br /> ChevronTexaco PM:M.Scott <br /> r, Mans�4iol,tLead Consultant,SAICC {D m <br /> S=H2SO4 O=Other <br /> IAUOFrVAdCja,o CeLWa." � 95 �d0 � <br /> Consultant/Office: �4, 7 317 <br /> C]J value reporting needed <br /> a. <br /> ❑3800 Watt Avenue, Suite 210,Sacramento,CA 95821 c <br /> �]. ti�[ HPP Risk Assessment Detection <br /> t- e U ❑ ❑ 0 w Z LUU Limits <br /> Consultant Prj.Mgr.:5�.� Y�C�1Yt:�t j <br /> o N �, �s �[' I { ❑Chromatograms <br /> CD <br /> Consultant Phone#: D �0 7Fax#: O 791? @20 © o 0 0 U, �' <br /> Sampler: I" , =y o 2 M M ¢ �s ! <br /> O Z � pNp N U { i <br /> Field Repeat Top Time Newo o `� 00 co <br /> w m = x co _ Q <br /> uj <br /> Point Name Matrix Sample Depth Year Month Day Collected Field Pt YIN t7 m a F- <br /> — Comments 1 Remarks <br /> 3 1 t ��tSe °n�lyzC �r <br /> S - O D P CIV 14 7 ty0o <br /> 1� <br /> --3 9 <br /> 11 <br /> I Z E <br /> 1 <br /> Turnaround Time Requested(TAT)(check box) Relinquished Diate Time Received by: Date Time <br /> TD.TAT ❑24 hour ❑48 hour 12W <br /> ❑ 5 day ❑ 72 hour ❑4 day Re' h by: Date Time Receiv Date Time <br /> Matrix Values Repeat Values Relinquished by: --rime Received by: Date Time <br /> S Soil D Duplicate sample Relinquishedb ommercial Carrier: Received by: Date Time <br /> W Surface Water or Groundwater T Triplicate Sample R <br /> T Trip Blank-QA Sample N Pre-Purge Sample UPS ted9k Other » 1 <br /> R Rinsate Blank-QA Sample P Post-Purge Sample <br /> M Miscellaneous(e.g.,product sample) Temperature/pH Upon Receipt),p)Co pH Custody Peals Intact? Yes No <br /> Lancaster Laboratories,Inc.,2425 New Holland Pike,PO Box 12425„Lancaster,PA 17605-2425 (717}656-2300 4324.01 Rev.1!14!05 <br /> Copies:White and yellow should accompany samples to Lancaster Laboraf6des. The pink copy should be retained by the client. <br />