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fIV&Lancaster Laboratories <br /> quality is a sciencep For Lancaster Laboratories use only <br /> ►Nhere . C� <br /> Please print Acct.#: Group# Sample#: <br /> Analyses Requested SCR#: <br /> Site/Global ID: f� � �; f"'�/ '',"� Preservation Codes Preservative Codes <br /> Site Address: H =HCI T=Thiosulfate <br /> ChevronTexaco PM:M.Scott Mansholt Lead Consultant:SAIC N = HNO3 B= NaOH <br /> iv S= H2SO4 O=Other <br /> Consultant/Office: ❑401 Alberto Way,Suite B, Los Gatos,CA 95032 L) <br /> C 0 N <br /> 3800 Wa p venue,Puite 210,Sacramento,CA 95821 _ <br /> - ❑J value reporting needed <br /> / c 05 z HPP Risk Assessment Detection <br /> Consultant Prj.Mgr.: J f (r, / f ^, El 11 'J o Limits <br /> Consultant Phone#: i o N N ❑ o o m -6FaX#: <br /> o � of o- U ❑Chromatograms <br /> ' - 2U <br /> Sampler. , -� .._�,,;,^I �•} -:� ..._�:.F.l;1`;' ;�.t^,r' El ❑ `n o o <br /> 4 .N :3co oM 2 2 U <br /> O Z cco ccoo N iA ui <br /> co <br /> Field Repeat Top Time New E m x wco co <br /> Point Name o o uj m = = = = � <br /> Matrix Sample Depth Year M_ nth Day Collected Feld Pt Y/N C9 U I— m a g <br /> /, 1 f( I '` Comments/Remarks <br /> O <br /> ! y.(r '. . .f• _._ c..,t , r / �' /� �7��-i ..,/ .�� i.i :�i ` , yy j'`' `/\�'I !Vii"!.°.'..i-41_�.. <br /> / 'E. <br /> Turnaround Time Requested (TAT)(check box) Reljrrquished by p�tp. �i e Received by: <br /> ! ), Date Time <br /> ❑ STD.TAT 24 hour ❑ 48 F %t%/ <br /> ❑ hour e r 1 jEl <br /> Date Time Received b <br /> 5 day ❑ 72 hour El 4 day a <br /> Relinquished by %" y: Date Time <br /> Matrix Values Repeat Values Relinquished by: Date Time Received by: Date Time <br /> S Soil D Duplicate sample <br /> W Surface Water or Groundwater T Triplicate Sample Relinquished by Commercial Carrier: Received by: <br /> T Tdp Blank-QA Sample N Pre-Purge Sample UPS FedEx Date Time <br /> R Rinsate Blank-QA Sample P Post-Purge Sample Other <br /> M Miscellaneous(e.g..product sample) Temperature/pH Upon Receipt CoH <br /> P Custody Seals 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 Laboratories. The pink copy should be retained by the client. <br />