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Lancaster „gym Laboratories 1 ��s.� Liv�,,,, For Lancaster Laboratories use only <br /> R�� iegt lityis<1sc�ence Acct.#; Group# Sample#: __-- --__-- — <br /> Please print, Analyses 62equested SCR#; <br /> Site/Global ID: Preservation Codes Preservative Codes <br /> Site,Address, <br /> H=HCI T=Thiosultate <br /> Q N = HNO3 B= NaOH <br /> „ c <br /> ChevronTexaco PM`"M.Scott Mansholt Leatl Consultant:SAIC S= H2SO4 C =Other <br /> Consultant/Office: El 401 Alberto Way,Suite B,Los Gatos,CA 95032CD ❑J value reporting needed <br /> X800 Watt Avenue,Suite 210,Sacramento,CA 95821c ElHPP Risk Assessment Detection <br /> ui Limits <br /> Consultant Prj.Mgr.: <br /> -- ---� o 4- 0 o _t5 ❑Chromato rams <br /> Consultant Phone#: Fax#: g <br /> — _ Q t�j „ o a <br /> Sampler: --- — cn � ti car <br /> Z ct� <br /> FieRepeat <br /> Point Name Matrix Sample Depth Year Month Day Collected Field Pt Y/N 0 Top Time New 0 1- CL F_ <br /> Z <br /> Comments 1 Remarks <br /> Turnaround Time Requested (TAT)(check box) Relinquished by: Date Time Received by: Date Time <br /> { STD.TAT El 24 hour ❑ 48 hour _ <br /> - Relinctiaished by: MDate Time Received r° Time <br /> 1_1 day �) 72 hour C� 4 day <br /> Matrix values Repeat Values Reim uis D � �a.� <br /> q r to Ilme Received y Date Time <br /> S <br /> Sol[ T Duplicate e sample Relinquiishee i ter € ��r: Received by: Date Time <br /> W Surface Wafer or Groundwater T Triplicate Sample <br /> T Trip Blank-QA Sample N Pre-Purge Sample UPS F�� Other <br /> R Rinsate Blank-QA Sample P Post-Purge Sample �Intact? <br /> �os�No��� <br /> M Miscellaneous(e.g.,product camp€e) Temperature/pH Upon Receipt C° pH Custody Seals <br /> Lancaster Laboratories, Inc.,2425 New Holland Pike,PO Bax 12425,Lancaster,PA 17605-2425 (717)655-2300 4324,01 Rev. 1/14/05 <br /> Copies:White and yFcftw shot ld accompany samples to Lancaster Laboratories, The:pink copy should be retained by tho€,k nt. <br />