Laserfiche WebLink
����rHislotical Pipeline Poftfio Analysis RequestlChain of Custody <br /> '�^����� For Lanvao�rLauo,�onesuse only <br /> �N� N0eneqma�y�aa�nce ��«����� Acct,#: ommo# Sample#: <br /> Please print Analyses Requested SCR#: <br /> Site/Global ID: . ..... Preservation Codes <br /> Preservative Codes <br /> Site Address: '__4 <br /> ChevronTexaco PM:M.Scott Mansholt Lead Consultant:SAIC <br /> Cons ultant/Office: 0401 Alberto Way,Suite B,Los Gatos,CA 95032 Q) Z 114 <br /> .6 []J value reporting needed <br /> N,3800 Watt Avenue,Suite 2101-5acramento,CA 95821 PHPP Risk Assessment Detection <br /> Consultant Prj.Mgr.: C) <br /> Consultant Phone 7 <br /> El <br /> Field Repeat Top Time New E X uj co co co < <br /> Point Name Matrix Sample Depth Year Month Day Collected Field Pt Y/N 0 ca CL <br /> Comments Remarks <br /> 'Turnaround Time Requested (TAT)(check box) Relinqui��hd Pate Time Received by: Qate Time <br /> 77 <br /> �ONTD.TAT 24 hour El 48 hour <br /> El 5 day El 72 hour El 4 day Relinquished by: Date Time Received by: Date Time <br /> Relinquished by: Date Time Received by: <br /> Matrix Values Repeat Values Date Time <br /> S Soil D Duplicate sample Relinquished by Commercial Carrier: Received by: <br /> W Surface Water or Groundwater T Triplicate Sample Date Time <br /> T Trip Blank-QA 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/pH Upon Receipt _Co_pH Custody Seals Intact? Yes No <br /> Lancaster Laboratories, |no..2425New Holland Pike,P0Box 12425. Lancaster,PA17OO5'2425 (717)656-230043z4.O1Rev. 1/1w»« <br /> Copies:White and yellow should accompany samples mLancaster Laboratories. The pink copy should ue retained bythe client. <br />