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it <br /> bmasber <br /> �,�,,� 2394 3 For Lancaster Laboratories use only <br /> i585CJE�1C� Acct.#: 1��( Group# t 35�o�os�o Sample#: <br /> Please print Analyses Requested SCR#. <br /> Site/Global ID: )�kl,�r 7 — Ve,-eiat 1(-5 Preservation Codes Preservative Codes <br /> H=HCl T=Thiosulfate <br /> Site Address: (,�14t11� CA n N=HNO3 B =NaOH <br /> ChevronTexaco PM: a onsu Mi�c oi�r � P S=H2SO4 O=Other <br /> 120 L) <br /> ConsultanUOffice:IN4 2 tyU�d�✓o�j� a ❑J value reporting needed <br /> S DoILliQ <br /> ❑•3�80�0 Watt Avenue,Suite 210,Sacramento,CA 95821 , �,� � o El C/) z HPP Risk Assessment Detection <br /> Consultant Pry.Mgr.: Y"1 1 I S Iowa l 0`1460 _U ❑ ❑ '> ❑ W Limits <br /> -7 � p U <br /> Consultant Phone#: I —(n / 6 S$ Fax M SA& 0 2 6 o ❑Chromatograms <br /> N N <br /> L O O <br /> aD O n <br /> Sampler: S. Gth kc 0 � M M a <br /> O. Z � O U <br /> _ v7 <br /> Field Repeat Top Time New m o ca "' H = = _ <br /> Point Name Matrix Sam le D� ear Month Day Collected newatrea c7 U Fo- m m <br /> r`p Comments/Remarks <br /> — 2,n Q 12 /T 7 X Say 1 = A�al�j� hAPs <br /> 2012- l 13 NLPS k X U 70 c s- <br /> O 1001, X k ��: �n�17?e Piol4S <br /> 1!2 <br /> ( I t 11:3��E l k >c F27a LV7 <br /> l,cg Gt! C/c�tw <br /> S►�_ _ zol ►2 ( 0100 k k S� l. <br /> Turnaround Time Requested(TAT)(check box) Relinquished by: 7D`ate Time Received by: Date Time <br /> $TD.TAT ❑24 hour El 48 hour t y l� 12pil <br /> ❑ 5'day ❑ 72 hour ❑4 day Relinquisheby: Date Time Received by: Date Time <br /> Matrix Values Repeat Values Relinquished by: Date Time Recei d by: Date Time <br /> 511, Soil D Duplicate sample ~ <br /> W Relinquished b Surface Water or Groundwater T Triplicate Sample ommercial Carrier: Re 'ved by: Da lime <br /> T 'v Trip Blank-QA Sample N Pre-Purge Sample UPS Fed Other I� <br /> R Rinsate Blank-QA Sample P Post-Purge Sample v <br /> M Miscellaneous(e.g.,product sample) Temperature/pH Upon Race Co pH Custody Seals Intact? No <br /> Lancaster Laboratories,Inc.,2425 New Holland Pike,PO Box 12425,Lancaster,PA 17605-2425 (717)656-2300 43241 Rev.1/14/% <br /> a Copies:White and yellow should accompany samples to Lancaster Laboratories. The pink copy should be retained by the client. <br /> Page 12 of 13 <br />