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1-abOrdiffR5 060b <br /> For La cat Laboratories use only r �-7 <br /> 11t�q [yB85 Ce Acct.#:� �1 Group# � Sample#: L4 ! —S00 <br /> Please print Analyses Requested SCR#: 1 <br /> Site/Global ID:—c->L OC�o 7 7�&2c 1 Preservation Codes Preservative Codes <br /> H=HCI T=Thiosulfate <br /> Site Address: ��NC,- L'ry�,,A 5 'rID g N=H NO3 B=NaOH <br /> co <br /> ChevronTexaco PM:M.Scott Mansholt Lead Consultant:SAIC m S=H2SO4 0=Other <br /> i [J <br /> Consultant/Office: El 401 Alberto Way,Suite B,Los Gatos,CA 95032 c� ❑J value reporting needed <br /> co a <br /> m 3800 Watt Avenue,Suite 210,Sacramento,CA 95821 c El HPP Risk Assessment Detection <br /> o ❑ `n z <br /> U ❑ ❑ ? o Limits <br /> Consultant Pr.Mgr.: f 1''f e yV Ow 1.5 <br /> CG� ^ o o o El Chromatograms <br /> � o �Consultant Phone S ✓ <br /> o o U) <br /> Sampler: •y Ec,� c) 0o � � <br /> O Z cc coN N W7co U U <br /> Field Repeat Top Time New m o ca w m= _ co _ <br /> Lu <br /> Point Name Matrix Sample Depth Year Month Day Collected Field Ptym (D U H Co 0- <br /> L.,3 _ W o 3 (p j S3Q Comments!Remarks <br /> Ai <br /> A I — V1 h I FF1 <br /> v <br /> Turnaround Time Requested(TAT)(check box) Reli ui , 2,)A-t9 L Time Recei� y: Date Time <br /> El STD.TAT El 24 hour 48 hour �J Z21 .9 Jy/" 2�2L <br /> ❑ 5 day El 72 hour 4 day Relinqui by: D t Time iced by: Date Time <br /> Matrix Values Repeat Values Relinquished by: Date Time Received by: Date Time <br /> S Soil D Duplicate sample Relinquished b mercial Carrier: i rte. <br /> d by: Dgite Ti <br /> W Surface Water or Groundwater T Triplicate Sample � 22 C, <br /> T Trip Blank-QA Sample N Pre-Purge Sample UPS Fed E Other U.0 4�e� <br /> R Rinsate Blank-QA Sample P Post-Purge Sample <br /> M Miscellaneous(e.g.,product sample) TemperaturelpH Upon Receipt C° pH ustody Seals lnt Yes No <br /> Lancaster Laboratories, Inc.,2425 New Holland Pike,PO Box 12425,Lancaster,PA 17605-2425 (717)656-2300 4324.01 Rev.1114105 <br /> Copies:White and yellow should accompany samples to Lancaster Laboratories. The pink copy should be retained by the client. <br />