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Histoficol Pipeline ' • 1 1 Analysis RequestlChoinof i1 <br /> LabO� 2219 For Lancaster�L`aborra�tories use only+L-anca� <br /> Ytr c tyisascrenm Acct.#: Group# 117 )&7Pr Sample#: S U� —90 <br /> Please print Analyses Requested SCR#: <br /> Site/Global ID: ) Preservation Codes Preservative Codes <br /> Site Address: <br /> 17190 Wes H=HCI T=Thiosulfate <br /> g N=HNO3 B=NaOH <br /> ChevronTexaco PM.M.Scott Mans olt Lead Con Itant SAIC ! � S=H2SO4 O=Other <br /> �,ICZ`17 � e[aZS Lam= CP( ! <br /> CortsultantlOffice: �r---- c� ❑J value reporting needed <br /> ❑3800 Watt Avenue,Suite 210,Sacramento,CA 95821 0 HPP Risk Assessment Detection <br /> rn z <br /> Consultant Pd.Mgr.: 4 El El <br /> --limits <br /> r_ ,,rr 1_ --�} o N N ❑ o0 ❑Chromatograms <br /> Consultant Phone#: 5-10 glo(D 71(j Fax#: �`7[U ` € a� o M CD n � <br /> m ❑ rn $ ao o <br /> Sampler: �, 3 m 0 0 2 M <br /> Z � N u� �n U <br /> a <br /> Field Repeat Top Time rnew � o o W m = CO = _ LULU <br /> Point Name Matrix Sample Depth Year Month Day Collected Field Pt Yrs 0 U i— m M � P <br /> Comments 1 Remarks <br /> �k — 0 <br /> AOMC6Cf Y5 cn ly. <br /> lr,�L& <br /> Yvt-A.q, .., <br /> '''' `a4,, sc� <br /> Turnaround Time Requested(TAT){check box} Relinquished by: Dat Time Received by: Date TiLl I me <br /> STD.TAT ❑24 hour ❑48 hour ]vJ=r <br /> ❑5 day El 72 hour El 4 day Relinquished by: Date Time Received by: ate Time <br /> Matrix Values Repeat Values Relinquished by: Date Time Received by: Late Time <br /> S Soil D Duplicate sample Relinquished rcial Carrier: ived by: Date Time <br /> W Surface Water or Groundwater T Triplicate Sample r <br /> T Trip Blank-QA Sample N Pre-Purge Sample UPS FedEx Other 1t•YB <br /> R Rinsate Blank-QA Sample P Post-Purge Sample -2 1 <br /> �y <br /> M Miscellaneous(e.g.,product sample) TemperaturelpH Upon Receipt Vim_co pH Custody Seals Intact? es No <br /> Lancaster Laboratories,Inc.,2425 New Holland Pike,PO Box 12425,Lancaster,PA 17605-2425 {717}656-2300 4324.01 Rev.1/14105 <br /> Copies:White and yellow should accompany samples to Lancaster Laboratories. The pink copy should be retained by the client. <br />