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Poddlid1 1 of Culstody <br /> Lw2ster LkwWies 0936 i l For Lancaster Laboratories use only <br /> VVf*W qa tyLSa S {Acct.#: 1 14 i�J Group# I V)lq O 9 Sample#:S 0 t)q Q Oo �s <br /> Please print Analyses Requested SCR#: <br /> Site/Global ID: %Kft14 fthb Preservation Codes Preservative Codes <br /> p� H=HCI T=Thiasulfate <br /> Site Address: + W. �"�[L� N=HNO3 B=NaOH <br /> ChevronTexaoo PM:M. colt Mansholt Lead Consultant: ICS , d S=H2SO4 O=Other <br /> +vim 41 4"(&0 E" <br /> ConsultantlOffice: ❑401 Alberto Way,Suite B,Los Gatos,CA 95032 = c� ❑J value reporting needed <br /> a <br /> ❑38 Watt A HPP Risk Assessment Detection <br /> Avenue, 214,Sacramento,CA 95821 0 ❑ ]� Cn z 'emits <br /> Consultant Prj.Mgr.: [r't �Q V J o L <br /> O N ElO� ❑Chromatograms <br /> Consultant Phone#:5,o'"4 717 Fax#: 51Q- 1u'�6-�l l (V co co N o o n <br /> 0 <br /> _�� 1 m O O 2 a <br /> Sampler: exa rJ 4 dr .01 ( Z m N M M 'n <br /> Field Repeat Top Time N o m co <br /> w m = i z m a <br /> Point Name Matrix Sample Depth Year Month Day Collected Field Pt YM 0) U F- m a F- � F- <br /> (,, C 13 Comments 1 Remarks <br /> ? o3 3 — Z <br /> 070313 aIS � <br /> 4b �M <br /> Tuound Time Requested (TAT)(check box) Relinqui d *atete lme 01 Received b <br /> V STD.TAT El 24 hour El 48 hour <br /> El5 day El 72 hour El4 day uished by: Time Received by: Date Time <br /> Matrix Values Repeat Values Relinquished by: to Time Received by: Date Time <br /> S Soil D Duplicate sample ReEinquished comer 'aI Carrier: iv by: D Time <br /> W Surface Water or Groundwater T Triplicate Sample <br /> T Trip Blank-QA Sample N Pre-Purge Sample UPS FedEx Other �- d7 <br /> R Rinsate Blank-QA Sanlp]a P Post-Purge Sample <br /> M Miscellaneous(e.g.,product sample) Temperature/pH Upon Receipt �-��C° pH f stody Seals"ot? Yes No <br /> Lancaster Laboratories,Inc.,2425 New Holland Pike,PO Box 12425,Lancaster,PA 17605-2425 (717}656-2300 4324.01 Rev. 1114105 <br /> Copies:White and yellow should accompany samples to Lancaster Laboratories. The pink copy should be retained by the client. <br />