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a _OW <br /> Histofical Pipeline Porftbfio Anolysis RequestlChoinof • • <br /> Lancaster Laboratories 1241 For Lancaster Laboratories use only <br /> Where gw1ftyisascience. Acct.#: Group# Sample#: _ <br /> Please print. Analyses Requested SCR#: <br /> Preservation Codes Preservative Codes <br /> Site/Global ID: H =HCI T=Thiosuifate <br /> '` a N =HNO3 B <br /> Site•Address: =NaOH <br /> .., �' S=H2SO4 O=Other <br /> ChevronTexaco PM'.M.Scott Mansholt LeConsultant:SAIC i <br /> Consultant/Office: ❑401 Alberto Way,Suite B,Los Gatos,CA 95032 c � N ❑J value reporting needed <br /> ❑HPP Risk Assessment Detection <br /> 3800 Watt Avenue,Suite 210,Sacramento,CA 95821 U EJLimits <br /> Consultant Prj.Mgr.: o J b ❑Chromatograms <br /> Consultant Phone#: Fax co <br /> E L) X <br /> Sampler. ,. ' a Z N �' o <br /> w co <br /> Field Repeat Top Time New m o o co <br /> zi <br /> Point Name Matrix Sample Depth Year Month Day Collected Field Pt O U �- [L w <br /> Comments/Remarks <br /> Relinquished by: 9 <br /> atg Time Received by: Date Time <br /> Turnaround Time Requested (TAT)(check box) 4. <br /> C <br /> STD.TAT ❑ 24 hour ❑ { Time Received D Time <br /> 48 hour Relingt jshed by: Date G <br /> ❑ 5 day ❑ 72 hour ❑ 4 day <br /> Relin uis to lme Receive y: / Date Time <br /> Matrix Values Repeat Values q `�2 <br /> S Soil D Duplicate sampleRelinuishe Received by: Date Time <br /> e�l r: <br /> W Surface Water or Groundwater T Triplicate Sample q :`�� Qther <br /> T Trip Blank-QA Sample N Pre-Purge Sample UPS -- <br /> R Rinsate Blank-QA Sample P Post-Purge Sample o H Custody Seals Intact? Yes No <br /> M Miscellaneous(e.g.,product sample) Temperature/pH Upon Receipt _C p <br /> 4324.01 Rev. 1114105 <br /> Lancaster Laboratories,Inc.,2425 New Holland Pike,PO Box 12425,Lancaster,PA 17605-2425 (717)656-2300 <br /> �. Copies:White and yellow should accompany samples to Lancaster Laboratories. The pink copy should be retained by the client. <br />