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� rx <br /> Laaster Laboratories 2399 2 For Lancaster Laboratories use only <br /> 1MleiequalityisasceirXe. Acct.#: I J Group#135 <br /> J5'jai U Sample#: G S'5P_IS.8—( 6 <br /> Please print Analyses Requested SCR#: <br /> Site/Global ID: Preservation Codes Preservative Codes <br /> 3-3 H = HCI T=Thiosulfate <br /> Site Address: t J N = HNO3 B=NaOH <br /> ChevronTexaco PM:114 On4XLead Consultant:SAIC 54 S= H2SO4 O=Other <br /> ` U <br /> ConsultanUOffice: 1-1401 AlbertWays,S)ite B,L atos,CA 950 J value reporting needed <br /> E? HPP Risk Assessment Detection <br /> cEl <br /> 02 El ElLimits <br /> Consultant Pr. Mgr.: Lr t o N N ❑ p C U El Chromatograms <br /> cif <br /> Consultant Phone#: J/�'� —�6 Fax#: / �' �i (1) W ° 0 0 o n <br /> L7 N 0 <br /> i E ❑ o c) o O O a <br /> Sampler: c o N 1E0 Z oNo cc C-4 "' "' to <br /> Field Repeat Top Time New 2 o m w m = _ <br /> LLJ <br /> Point Name Matdx Sample Depth Year Month Day Collected Field Pt YIN 0 U � m a a <br /> 1j Comments/Remarks <br /> J i <br /> Turnaround Time Requested (TAT)(check box) Relinquished b Date Time Received by: V Date Time <br /> TD.TAT ❑ 24 hour ❑ 48 hour <br /> ❑ 5 day ❑ 72 hour LJ 4 day Relinquished by: Date Time Received by: Date Time <br /> Matrix Values Repeat Values Relinquished by: Date Time Received by: to Time <br /> S Soil D Duplicate sample RelinquishedME <br /> mercial 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 Other <br /> R Rinsate Blank-QA Sample P Post-Purge Sample <br /> M Miscellaneous(e.g.,product sample) Temperature/pH Upon Receipt t,D C° pH Custody Seals Intact? (7, <br /> s 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 sampletoo Len ylef Laboratories. The pink copy should be retained by the client. <br /> 1:i A <br />