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I: Histoficol Pipeline Porffofid Anolysis RequestlChoinof • • Laxaster LaNmlodes 2 2 5 0 +� For Lancaster Laboratories use only/ Wherrequalk) ;a5ClE�t[E'. Acct.# / Group C Q0' 97_4 Sample#: �d`3 7,3k1,!�_ Please crint Analyses Requested SCR#: Site/Global ID:� Ill Preservation Codes Preservative Codes Site Address: W,4 - H= HCI T=Thiosulfate n N= HNO3 B= Nai �� _ ChevronTexaco PM: S Lead COTIS pant: S C m S = H2SO4 O = Other I �l Etlt✓Gr + �� m Consultant/Office: L s N C 0 ❑J value reporting needed O 3800 Watt Avenue, Suite 210,Sacrame CA 95821 c \ / o z HPp Risk Assessment Detection Consultant Prj.Mgr.: L ]�t� tf U ❑ [l ? o Limits o �, �, ❑ o o ❑Chromatograms Consultant Phone#: �� ? a r Fax /�/�� w m o a , Sampler: E o 0 0 0 0Or Q 0 Z ro m N U Field Repeat Top Time New m E =° w m = _ = i < Point Name Matrix Sample Depth Year Month Day Coltected Fleld PtY1N U U m Q ,`- ,a i 1 Corrjments!Remarks J/ 0 5 s� v Reli she b Tu around Time Requested(TAT)(check box) Date Time Received Date TimeT� TD TAT ❑ 24 hour ❑ 48 hour 5 day L 72 hour ❑ 4 day Re quished by Date Time Re ived by: Date Time Matrix Values Repeat Values Relinquished by: Date Time Receive by: Date Time S Soil D Duplicate sample W Surface water er Groundwater T Triplicate Sample Relinquished by Commercial Carrier: Received by: to Time T Trip Blank-QA Sample N Pre-Purge Sample UPS FedEx Other R Rinsate Blank-QA Sample P Post-Purge Sample a M Miscelianeous(e.g.,product sample) Temperature/pH Upon Receipt` ��rC° pH als Intact? Yes No Lancaster Laboratories..Inc.,2425 New Holland Pike,PO Box 12425,Lancaster,PA 17605-2425 (717)656-2300 4324.01 Rev. 1/14/05 Copies:White and yellow should accompany samples to Lancaster Laboratories. The pink copy should be retained by the client.