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i i i i l i l i l i i i i l i i l i i <br /> Lancaster Ubomtories 0722 J f ` n` For Lancaster Laboratories use only / <br /> UVFlare QUaNfyS a SCtence Acct.#: 1 "C [J Group# IL!d 31'�� Sample <br /> Please print Analyses Requested <br /> SCR#: 3 7 7 <br /> SitelGlobal ID: C f M n SLOIioll 44FKPros atiop Codes Preservative Codes <br /> e H=HCI T=Thiosulfate <br /> Site Address: S 'C'ook �1 Y j1� lfS a N=HNO3 B=NaOH <br /> BSS R� r15 Denra's, 13VO S=H2SO4 O=Other <br /> ChevronTexaco PM:M.Scott Mansholt Lead Consultaht:S I <br /> Lo U <br /> Consultant/Office: ❑401 Alberto Way,Suite B,Los Gatos,CA 95032 m ❑J value reporting needed <br /> 'V3800 Watt Avenue,Suite 210,Sacramento,CA 95821 Q ❑ , ❑HPP Risk Assessment Detection <br /> �1r t 5 ( Ul l'1U Limits <br /> Consultant Pd.Mgr.: C � (s, o J � ❑Chromatograms <br /> Consultant Phone#: Fax M qt LQ q J- -3 <br /> Sampler: �' JC1y1CYlr nY)�+c(OL 1 0 ti <br /> a Z m o <br /> Field Repeat Top Time New o o y = <br /> Point Name Matrix Sample Depth Year Month Day Collected Flatd Pt YIN 0 U l' <br /> N k U 61 2 q ( x Comments 1 Remarks <br /> tk 1 2q X X � 501'-a iCa el <br /> 4J Na N I 6100 !� X 17- X ------------- <br /> ai d <br /> v <br /> 14+1 <br /> e�� litYl�fS <br /> �ts�r�so <br /> Turnaround Time Requested (TAT)(check box) inqu' h d by: at Time by: Date Time <br /> LSTD.TAT El 24 hour El 48 hour '; © �r <br /> ❑ 5 day ❑ 72 hour ❑4 day MRriuish <br /> y: ate Tiim�e, Receiv by: Dae Time <br /> Matrix Values Repeat Values Date Time Received by: Date Time <br /> S Sr T Duplicate sample Relinquished b Commercial Z'arrier: Received by Date Time <br /> W Surface Water or Groundwater T Triplicate sample <br /> T Trip Blank-QA Sample N Pre-Purge Sample UPS Fe Other WI 4 Qqj� <br /> R Rinsate Blank-QA Sample P Post-Purge Sample l <br /> M Miscellaneous(e.g.,product sample) Temperature/pH Upon Receipt 6 r7,G.C' C° pH Custody Se ct? 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 samples to Lancaster Laboratories. The pink copy should be retained by the client. <br />