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*La�Uwaw5 O O 5 55For Lancaster Laboratories use only <br /> Acct.#: 1I`i i t3 Group# Cj"!S� Sample#: L�' �a Q co <br /> Please printvufk*19 JpkW? Gler-(aAI Analyses Requested SCR#: <br /> Site/Global ID: V v6 —�r —00 3 Preservation Codes Preservative Codes <br /> Site Address: ® W e L YY rw_ VM41op'5'` — H=HCI T=Thiosulfate <br /> ' N=HNO3 B=NaOH <br /> ChevronTexaco PM:M.Scott Mansholt Lead Consultant:SAIC S=H2SO4 O=Other <br /> U <br /> ConsultanVOf ice: ❑401 Alberto Way,Suite B,Los Gatos,CA 95032 _ n, <br /> C ❑J value reporting needed <br /> DD Watt Avenue,Suite 210,Sacramento,CA 95821 El 'z ❑HPP Risk Assessment Detection <br /> Cn <br /> ll 7'I� U �t ❑ Q Limits <br /> Consultant Prj.Mgr.: _ <br /> Consultant Phone#: �3 L Fax#: `�`J�f Z�� `" ' o o ❑Chromatograms <br /> i C7 O U <br /> Sampler: ('.f C � i E ❑ 0 o o po M <br /> 0 0 <br /> oZ � " o g a <br /> Z ccoo co N L v <br /> Field Repeat Top Time New m o w o x x = <br /> Point Name Matrix Sample Depth Year Month Day Collected Field Pt YIN 0 U H m a P EL CL <br /> © -Ds- is Comments l Remarks <br /> ZAt �. a5—05-1 I7 0 x WwV41n M !N <br /> ar/ <br /> TP del <br /> S�- <br /> 55.5 <br /> Turnaround Time Requested(TAT)(check box) to Time Received by: Date Time <br /> STD.TAT ❑24 hour ❑48 hour Ib•M <br /> ❑5 day ❑72 hour ❑4 day [FRq5eftnqued by: Date Time Receive Date Time <br /> Matrix Values Repeat Values Relinquished by: Date Time Received by: Date Time <br /> S soil D Duplicate sample <br /> W Surface Water or Groundwater T Triplicate Sample Relinquished ercial Carrier: ved by: Q e Ti <br /> lle <br /> T Trip Blank-QA Sample N Pre-Purge Sample UPS FedEx Other <br /> R Rinsate Blank-QA Sample P Post-Purge Sample1 <br /> M Miscellaneous(e.g.,product sample) Temperature/pH Upon Receipt Co pH ustody Seal I ct? rYe, o <br /> Lancaster Laboratories,Inc.,2425 New Holland Pike,PO Box 12425,Lancaster,PA 17605-2425 (717)656-2340 4324.03 Rev. 1174105 <br /> Copies:White and yellow should accompany samples to Lancaster Laboratories. The pink oopy should be retained by the client. <br />