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Historicial PipelinePoddlio Anolysis RequestlChoinofCustody- For Lancaster Laboratories 2 3 0 5 G #i �ig i ries use only�� 1M�erequaktyisasctence. Acct.#: -I �-J Sam le#: Please print Analyses Requested SCR#: Preservation Codes Preservative Codes Site/Global ID o frIAOX H= HCI T=Thiosulfate Site Address: 33' V&r Q C N= HNO3 B=NaOH / V1#VW1 S= H2SO4 O=Other ChevronTexaco PM:NM-6cct4eas1aelt L ad Consultant:SAIC a� ^� ❑J value reporting needed Consultant/Office: E1401 Alberto Way,Suite B,Los Gatos,CA 95032 � a HPP Risk Assessment Detection ❑3800 Watt Avenue,Suite 210,Sacramento,CA 958210 ❑ Cn z mits ❑ El! U J 0 a Consultant Prj. Mgr.: /\ o El Chromatograms N 0 0 0 U Consultant Phone#: �� Fax#: Q_ cO - 0 0 0 f- o Sampler: C n t r� �.- W D `D N r 0 CL Z o � a Field Repeat op Time New m o o w m a a a Lu Point Name Matrix Sample Depth Year Month Day Collected Field Pt Y/N v � m ~ S 'Z O I O Comments J Remarks s 12 o o t2 p X & '2c D t x � N 2 1 33 HIS �-P Aff R b at Time Received by: Date Time Turnaround Time Requested(TAT)(check box) �3TD,TAT E 24 hour El48 hour Date Time Received by: Date Time El day El 72 hour El day e inquished by: Matrix Values Repeat Values Relinquished by: Date Time Received by: ate Time S Soil D Duplicate sample Relinquished by ercial Carrier: Received y: Date Time W Surface Water or Groundwater T Triplicate Sample /�/ 1/ T Trip Blank-QA Sample N Pre-Purge Sample UPS dE Other 1.)- / R Rinsate Blank-QA Sample P Post-Purge Sample M Miscellaneous(e.g.,product sample) Temperature/pH Upon Receipt C° pH Custody Seals Intact? Y No 4324.01 Rev. 1/14/05 Lancaster Laboratories, Inc.,2425 New Holland Pike, PO Box 12425,Lancaster, PA 17605-2425 (717)656-2300 Copies:White and yellow should accompany samples to Lancaster Laboratories. The pink copy should be retained by the client.