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T <br /> Historkal Pipehne Por. • • Analysis RequestlChainof Custody <br /> Lancaster 0963 For Lancaster Laboratories use only r ,f <br /> f L cjakyisascience. �rcct.#: {�`I� Group# 1 -71 3 Sample#: 5�390C/a — `7`O <br /> Please print Analyses Requested SCR#: <br /> Site/Global ID: J Preservation Codes Preservative Codes <br /> r �r._-v H=HCI T=Thiosulfate <br /> ► <br /> Site Address: 'O I/� + iPl Q- N=HNO3 B=NaOH <br /> ChevronTexaoo PM:M.Scott Mansholt Lead Consultant:SAIC u S=H2SO4 O=Other <br /> Consultant/Office: u c� Q ❑J value reporting needed <br /> m HPP Risk Assessment Detection <br /> ❑3800 Watt Avenue,Suite 210,Sacramento,CA 95821 c <br /> / a © "' z imits <br /> Consultant Prj.Mgr.: U ❑ ❑ �' ❑ a <br /> I1 o 0 0 QChromatograms <br /> of ac 0 <br /> Consultant Phone#: v — "7/ Fax#: -71-14 (D 00 c 0 <br /> ot I E 0 o o g a <br /> Sampler: f cn Z N C:, <br /> Field Repeat Top Time New o 0 � m = s x z <br /> Point Name Matrix Sample Depth Year Month Day Collected Field Pt YIN U H m a F- � <br /> 9' �! Comments!Remarks <br /> 1 DV I 1 . ml� <br /> GLI <br /> Pal <br /> Turnaround Time Requested(TAT).(check box) Relinquished by: to Time Received by: Date Time <br /> STD.TAT El 24 hour ❑48 hour <br /> ❑ 5 day El 72 hour El 4 day Relinquished by: Date Time Received b , Elate Time. <br /> Matrix Values Repeat Values Relinquished by: Date Time �e�ved by: Date Time <br /> — <br /> Matrix <br /> Soil D Duplicate sample <br /> W Surface Water or Groundwater T Triplicate Sample Relinquishe y e ial Carrier: Rece ed ate Time <br /> T Trip Blank-OA Sample N Pre-Purge Sample UPS FedEx Other <br /> R Rinsate Blank-QA Sample P Post-Purge Sample <br /> M Miscellaneous(e.g.,product sample) Temperature on Receipt 6"5" C° pH o als tact? &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 />