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e '' <br /> ® e - , . . e 0 <br /> o <br /> ' L�ner C�ar� � ies Q 2. <br /> . wr>ry � n: <br /> For;Lancaster Laboratoriesuse only <br /> Acct # ". Group# Sample#: <br /> Please print <br /> Analyses requested SCR#:; <br /> 5itelGlobai l©: �r3 t tt? r3(r )`° • , Preservatiot�Codes ' <br /> Preservative Codes <br /> Site Address: €, i 'i �Ff i'.t,r °i w: :i ,e t .> = H HCl T-.:Thiosulfate <br /> N= Hl�[03 B=NaOH <br /> ChevronTexaco. . M.Scott Mansholt Lead Consultant:SAIC l i S=.i 12SO4 . . . her <br /> ConsultantlOffice. 040.7 Alberto'Way,Suite B,Los Gatos,>CA 95032 <br /> ,0 3800 Watt Avenue,Suite 210,Sacraniento,CA 9582! B <br /> DO value reporting needed <br /> �' © m : O HPP Risk Assessment©etection <br /> Consultant Prj.Mgr �� i,:a <br /> ... 1 1.t p Limits <br /> GCnsulfant Phone# i ., FaX ` ❑Chromatograms <br /> # f, :, 3 m <br /> Sampler j 1=1 n 1 "' m o <br /> Z N . <br /> Field fiepeat Top Time New o " .% _ ;� t <br /> Point Name Matrix Sample Depth Year Month:l3a 1�- ¢ 0.. � , <br /> y Colleetetl Field Pt v!N �: U i <br /> o. <br /> � l r . t <br /> 't �; f c ` tat, 4 r - <br /> r I• s 1 Remarks <br /> l ,. Comment <br /> ' '. �°", !mak w�"511AF ` F f �` t� .r. <br /> y <br /> l t 3 i' � `nj 1. ,-a <br /> _ ..s2 <br /> i` <br /> L t 1a <br /> e :;: <br /> Turnaround Time Requested(TAT)(check box) i `Iinqu sh ',d by: �'r Date Time I - "d by r. Date Time <br /> ❑ 24 hour ❑4$hour a ;c F F { ~:.; ,y , <br /> 0 5 day ❑ 72 hour ❑ 4 day a.[i ishd by Date Time Received;by "'` C1ate Time <br /> . . . Values Repeat Values Reil quashed by` Date Time Received by: ©ate Time l <br /> S Soil t7upUcate sample <br /> W Surface Water nr Groundwater T Thplicaie Sample Ral�nquisherl by GoriinlerCialGarrier Received'by Date Trine <br /> T Trip Blank i�R Sample N Pre-Purge Sample UPS Fedex Other f ; <br /> R Rinsate Blank-OA Sample: P Post-Purge Sample ; <br /> M Miscellanenus.(e.g product;sample) Temperature/pH Upon Receipt C° pH <br /> — <br /> Custody Seals lrtfact?. Yes No <br /> Lancaster Laboratories,Ir1c.,2425:New Holland Pike,PO Bax 12425;Lancaster PA 17605- 4324Oi Rev.<i <br /> 2. .. (717)656 2300 li4/05 <br /> Copies . . .and yello w should accompany samples to Lancaster Laboratories. The pink copy should be re#atned by the:clienf: <br /> i <br />