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• • • ' � • 1 • i 1 1 <br /> �� 0099 QF� `J For Lan ter L.aboratorieuse only a 3 I3 ya <br /> rpi}tg85ClE,tiC� Acct.#: ��"5� Group# O��4S Sample#: <br /> ■,� � ��/V,� Analyses Requested SCR#: <br /> VFK 1/�/y[ <br /> Please print y <br /> _ 3 _ Preservation Codes Preservative Codes <br /> Site/Global ID: H=HCl T=Thiosul#ate <br /> SSiyO wGL W1��ril' rL <br /> 4d=HNO3 B=NaOH <br /> Site Address: 5- <br /> i S=H2SO4 O=Other <br /> ChevronTexaco PM:M.Scott Mansholt Lead Consultant:SAiC <br /> Q n ❑J value reporting needed <br /> Consultant/Cffice: ❑401 Alberto Way,Suite B,Los Gatos,CA 95032 10p <br /> PP Risk Assessment Detection <br /> K800 Watt Avenue,Suite 210,Sacramento,CA 95821 o m ?_ units <br /> ��n ❑ J ❑ " ❑Chromatograms <br /> Consultant Pry.Mgr.: 1� S] 2� o o N O 'n C <br /> Consultant Phone#: Fax#: o <br /> L(/ �-.f 1 C► 0 3 N N O �fl tf) U <br /> Sampler: co <br /> o Z m °o m o 0 0 Cn <br /> Field CD <br /> Repeat Top <br /> Time "e" t7 U m a a- w <br /> Point!Name Matrix Sample Depth Year Month Day Collected Field Perna Comments 1 Remarks <br /> 117' 7�7 0 5-15 _T <br /> S s—a — 1 1Gr exp <br /> s-�� •Sv T-04 At L_ <br /> Date ime Rece ed by: Date Time <br /> Turnaround Time Requested(TAT)(check box) <br /> Re ish -� 0 <br /> XSTD.TAT 1124 hour ❑48 hour R quished by: Date Time Received by: Date Time <br /> ❑ 5 day ❑ 72 hour ❑ 4 day <br /> Relinquished by: <br /> Date Time Received by: ate Time <br /> Matrix Values Repeat Values <br /> i ed by: ate Ti <br /> S Soil D Duplicate sample Relinquished b ercial Carrier: <br /> - <br /> W Surface Water or Groundwater T Triplicate Sample <br /> T Trip Blank-QA Sample N Pre-Purge Sample UPS FedEx Other <br /> R Rinsate Blank-QA Sample P Post-Purge Sample H dy Seal n ct? Yes 0 <br /> M Miscellaneous(e.g.,product sample) TemperaturelpH Upon Receipt C° P sto <br /> 4324.01 Rev. 1114/05 <br /> Lancaster Laboratories,Inc.,2425 New Holland Pike,PO Box 12425,Lancaster,PA 17605-2425 (717)656-2300 <br /> Copies:White and yellow should accompany samples to Lancaster Laboratories. The pink copy should be retained by the client. <br />