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'torical Pipeline Poftofio Analysis RequestlChain Of Custody, <br /> thfis <br /> Lvicaster Labimbies 0962 1 For Lancaster Laboratories use only <br /> w�recjalityisascrerice• Acct.#: 1 I q )3 Group# 7 QY Q I Sample#: 3 33�� Q <br /> Please print Analyses Requested SCR#: <br /> Site/Global ID: Hm <br /> ` Preservation Codes Preservative Codes <br /> H=HCI T= <br /> Site Address: �Gf�II A C NaOH!fate <br /> N=HNO3 B=NaOH <br /> ChevronTexaco PM:M.ScottMansh It Lead Consy{itant:SAIC 2 S=H2SO4 O=Other <br /> 10003 <br /> "' "' $ "' �o�yR�� ` ��" c ❑J va€ue reporting needed <br /> ConsultanttOffice: aaa �a-, co <br /> El 31300 Watt Avenue,Suite 210,Sacramento,CA 55821 c M z <br /> PfVPP Risk Assessment Detection <br /> Consultant Prj.Mgr.: 0 ❑ ❑ Limits <br /> J 0 U <br /> rr111 r,, 4!Y1' � o N � ❑ 00 0 = ❑Chromatograms <br /> TuT1S�—+ i i 1 c// a� co <br /> Consultant Phone#: [ Fax#: "�`7 ❑ N o 0 o g <br /> Sampler: �',�$�� Z �it iffi �n o g <br /> Z N U <br /> ❑_ °p m o U <br /> B <br /> w <br /> W z <br /> Field Repeat Top Time New T o _ = x <br /> Point Name Ma Sample Depth Year Month Day Collected FleldRYiN 0 U m Q <br /> 56- 37— �— �� p 0 Comments 1 Remarks <br /> I o Wo 2 <br /> (D IZ30 Y <br /> — as o CA ec-,n oY <br /> nftLS a �JVA <br /> aF t6. <br /> sg-3s <br /> Turnaround Time Requested(TAT)(check box) Relinquis d by: Time Re ' ed by: Date Time <br /> STD.TAT ❑ 24 hour ❑ 48 hour YgS <br /> El5 day El72 hour El4 day Reli 6ate Time Received by: Date Time <br /> Matrix Values Repeat Values Relinquished by: to Time Received by: Time <br /> S Soil D Duplicate sample Relinquished b ercial 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 1pz� Other <br /> R Rinsate Blank-QA Sample P Post-Purge Sample <br /> M Miscellaneous(e.g.,product sample) Temperature/pH Upon Receipt L _Co pH r Custody S aIs Intact? Ye No <br /> Lancaster Laboratories,Inc.,2425 New Holland Pike,PO Box 12425,Lancaster,PA 17605-2425 (717)656-2300 4324.01 Rev. 1114/05 <br /> Copies:White and yellow should accompany samples to Lancaster Laboratories. The pink copy should be retained by the client. <br />