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� nLGIJler Lo� ` C1es ' For Lancaster Laboratories use only <br /> Where qu, is a science <br /> � _,12 Acct # Grou Sample#: <br /> Please print <br /> Analyses Requested SCR#: <br /> Site/Global ID: � " � {� 7,77 Preservation Codes Preservative Codes <br /> Site Address: ` H = HCl T=Thiosulfate <br /> ' c <br /> N = HNO3 B=NaOH <br /> ChevronTexaco PM.M.Scott_Ma`nsholt',Lead Consioant;SAIL S= H2SO4 O=Other <br /> Consultant/Office.- 0401 Alber(o Wa � ' <br /> i U <br /> Ytlite B, Los Gt03,CAQ, 0 N <br /> .t ;p k �,1, .. y`= 5 ❑J value reporting needed <br /> a <br /> ❑38001Navenue�Site 2tF3 =, 74 <br /> 821 c ❑ U, z ❑HPP Risk Assessment Detection <br /> t ` O Limits <br /> Consultant Pi MgG l .:4~ t W 11r �. :� r K U > w <br /> Elp U <br /> Consultan - M o ❑ o o o ❑Chromatograms <br /> t,Pf Dne#. Fax#: t`�' e - ( 0 o v v <br /> Samplpt �� ' q ;-, _ � :. a? 0 0 0` <br /> — ( E coo <br /> U <br /> Field Repeat Top Time New ;o, o x w .� o <br /> Lu m x x x a- Lu :. <br /> Point NaA"i'e Matrix Sample Depth Year Month Day Collected Field Pt C7 U t- m a <br /> "" <br /> C7 777 <br /> I t`� ' -' Al, Comments/Remarks <br /> y e.F',-� iA r` ! ti... _ n"" <br /> Turnaround Time Requested(TAT)(check box) Relinquished by ,. patq Time Received by; Date Time <br /> r � j <br /> Vis. 7��:/1-). _ _ ., `_; <br /> 91STD.TAT ❑ 24 hour ❑ 48 hour !LL; ,, <br /> 5 day ❑ 72 hour ❑ 4 da Relinquished by: Date Time Received b <br /> Y Y: Date Time <br /> Matrix Values Repeat Values Relinquished by: Date Time Received by: Date Time <br /> S Soil D Duplicate sample Relinquished b Commercial Carrier: <br /> W Surface Water or Groundwater T Triplicate Sample q Y Received by: Date Time <br /> T Trip Blank-QA Sample N Pre-Purge Sample UPS FedEx Other <br /> R Rinsate Blank-QA Sample P Post-Purge Sample <br /> M Miscellaneous(e.g.,product sample) Temperature/pH Upon Receipt C. pH Custody Seals Intact? Yes No <br /> Lancaster Laboratories, Inc.,2425 New Holland Pike, PO Box 12425, Lancaster, PA 17605-2425 (717)656-2300 4324.01 Rev. 1/14/05 <br /> Copies:White and yellow should accompany samples to Lancaster Laboratories. The pink copy should be retained by the client. <br />