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Histodcoi Pipeline PorffofidAnolysisRequestlOhoinofCustody *Lwcaster Laboratories O For Lancaster Laboratories use only / Wlrereq[Ia6ty6a5GertCE Acct.#: Group# �33 Y71 le Sample#: -t0�D`t I [ '7 3 Please print Analyses Requested SCR#: Site/Global ID:_Aher &1 Preservation Codes Preservative Codes 33 l/1Q S Ci H=HCl T=Thiosulfate "141Site Address: !� 5A I N=HNO3 B=NaOH ChevronTexaco PM: Lea onsultant:SAIC S=H2SO4 O=Other ` U Consultant/Office: ❑401 Alberto Way,Suite B,Los Gatos,CA 95032 W ❑J value reporting needed 3800 Watt Avenue,Suite 210,,Sacramento,CA 95821 c z HPP Risk Assessment Detection Consultant P1.Mgr.: VJ F/ a4vi Sjow;/ U ❑ ❑ J wo Limits ��y�r- o Elo0 o0 = ❑Chromatograms Consultant Phone#: r/'� /�9 Fax#: 52500 P `y $ M 0 o - EJ55 m U 0 Sampler: y � � o d Q ZW ip N 12 u ii J) ve m o c m= = co Field Repeat Top Time Now Point Name Matrix Sample Depth Year Month Day Collected Flsld Pt YM v m a IZ a \/V 0 Comments/Remarks u' 5i l Fol— ==P / Turnaround Time Requested(TAT)(check box) Relinquishe t— /Date Time Received by Date Time ATD.TAT El 24 hour 1148 hour ❑ 5 day El hour 114 day Relinquished by: Date Time Received by: Date Time Matrix Values Repeat Values Relinquished by: Date Time Received by: Date Time S Soil T Duplicate sample Relinquished ercial Carrier: Receiv d b W Surface Water or Groundwater T Triplicate Sample Y: Dt( T' e T Trip Blank-QA Sample N Pre-Purge Sample UPS FedEx Other R Rinsate Blank-QA Sample P Post-Purge Sample M Miscellaneous(e.g.,product sample) Temperature/pH Upon Receipt C° pH Custody Sealsact? Me, 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.