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Historical Pipeline Poftfio Analysis RequestlChain of Custody <br /> es For Lancaster Laboratories use only <br /> I�Lancasterbboratoe 2213 <br /> 'i Wlx:-re quality is a scier" <br /> Acct. <br /> Group# Sample <br /> Please print Analyses Requested SCR#: <br /> Site/Global ID: <br /> Preservation Codes Preservative Codes <br /> Co 0 <br /> (D 7, H = HCI T=Thiosulfate <br /> Site Address: <br /> N = HNO3 B=NaOH <br /> ChevronTexaco PM:M.Scott Mansholt Lead CoFullgint:S' S= H2SO4 0=Other <br /> f'-' I <br /> Consultant/Office: Q) 75 <br /> 0 N E]J value reporting needed <br /> ❑3800 Waft Avenue,Suite 210,Sacramento, CA 958�1 c El V) <br /> 0 z El HPP Risk Assessment Detection <br /> > Limits <br /> Consultant Prj.Mgr.: z_.r a- Z Av,1�1 <br /> El 0 0 -6 El Chromatograms <br /> CDCD2WWC) <br /> Consultant Phone#: Fax#: 9 r9— �'7 -'3 Q) W <br /> Q) -0 <br /> Sampler: :t-_ E 8 u 0 0 0 M <br /> =; ID CD M n 2 < <br /> 0 Z C14 C\j lc-,- U.) U.) <br /> Field Repeat Top Time New -0 EB x Lu <br /> 0 0 < <br /> Lu Co <br /> Point Name Matrix iSample Depth 1Year Month Day Collected FieldPtY/N (D 0 F— <br /> G; 17 I Comments I Remarks <br /> "1 7�A�' 'r <br /> ------------ <br /> - Relinqui bey <br /> --------------- <br /> : <br /> Turnaround Time Requested(TAT)(check box) Time Rece#ed by,,/ Time <br /> STD.TAT El 24 hour El 48 hour <br /> 5 day El 72 hour El 4 day Relinquished bli­ Date Time Received by: Date Time <br /> Matrix Values Repeat Values Relinquished by: Date Time Received by: Date Time <br /> S Soil D Duplicate sample Relinquished commercial Carrier: Received by: <br /> W Surface Water or Groundwater T Triplicate Sample Date Time <br /> T Trip Blank-QA Sample N Pre-Purge Sample UPS ,Fed!��, Other <br /> R Rinsate Blank-QA Sample P Post-Purge Sample <br /> M Miscellaneous(e.g.,product sample) Temperature/pH Upon Receipt _Co pH Custody Seals Intact? Yes No <br /> I F1 <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 />