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• 1 ' 1 — <br /> V. r��� 2213 For Lancaster Laboratories use only <br /> LAhae ualityisa5[iwoe. Acct.#: —i! Group# l ! w 7 7o Sample#:6--V j tai?! ! <br /> Please print <br /> Analyses Requested SCR#: <br /> Site/Global ID: Com` Ot(t c' Sfakm �LO(a.X77 q Xes33 Preservation Cod <br /> -7 r Preservative Codes <br /> Site Address: c7pOs{'1�t [!�f'� y �,n , a H =HCI T=Thiosulfate <br /> N=HNO3 B=NaOH <br /> ChevronTexaco PM:M.Scott Manshglt Lead Co ulta-nt:SAIC <br /> S=H2SO4 O=Other <br /> .1000 arto�o-ryConsultant/Office: <br /> N ❑J value reporting needed <br /> ❑3800 Watt Avenue,Suite 210,Sacramento,CA 95821 ° a. <br /> (+ r [��� � ❑ CO z ❑HPP Risk Assessment Detection <br /> rl 9h�P h Ox Clef -{_ O <br /> Consultant P'.Mgr.:: ��r yn f�yl i 1T "� () ❑ ❑ J o 0 Limits <br /> Consultant Phone#: 1Q--'1b d 71 Z7 Fax#: 9 r� -3j o Z7 C> ❑ o o ❑Chromatograrns <br /> C) 60 m 2 0 0 U U <br /> Sampler: A. Snoi +i 0 El 13 co 0 0 0 <br /> N :3 N N CD 2 M sn U <br /> O Z co m N u� �n <br /> Field 1;Sam9ple <br /> Top Time t m o m w m = _ _ a <br /> Point Name Matrix Depth Year Month Day Collected Field Pt YIN 0 U H m a g <br /> C.pt i RYY-lp — OV' 07 17 19'4 5 2I Comments 1 Remarks <br /> Ss16o__Se✓ <br /> 0 <br /> Turnaround Time Requested TAT check box Relinquis y: Time <br /> q ) ate Time Rec ' by: <br /> ❑ STD.TAT ❑ 24 hour ❑48 hour l L+ <br /> 5 day ❑ 72 hour ❑4 day Relinquished b Date a Received by: 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 b Commercial Carrier: qe ived 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 66��l1 <br /> M Miscellaneous(e.g.,product sample) Temperature/pH Upon Receipt �C. H <br /> A dySUals Intact? Yes No <br /> Lancaster Laboratories,Inc.,2425 New Holland Pike,PO Box 12425,Lancaster,PA 17605-2425 (717)656-2300 4324.01 Rev. 1/14105 <br /> Copies:White and yellow should accompany samples to Lancaster Laboratories. The pink copy should be retained by the client. <br />