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HiStofical Pipeline Porffofib Analysis RequestlChain of Custody Uxaster Umbies 0106 For MeM'5-170 borries use only mwe y sascier�ce. Acct.#: Group Sample#: Please print Analyses Requested _SCR#: Site/Global ID: ' :5 QW 77Yf9 33 Preservation Codes Preservative Codes / Site Address: f�ermd 1,6 too±m,o S'T,4no'oj H=HCi T=Thiosulfate CL N=HNO3 B=NaOH ChevronTexaco PM:M.Scott Mansholt Lead Consultant:SAIL a S=H2SO4 O=Other Consultant/Office: ❑401 Alberto Way,Suite B,Los Gatos,CA 95032 Qm , S ❑J value reporting needed LV3800 Watt Avenue,Suite 210,Sacramento,CA 95821 �° " a `` ❑H P P Risk Assessment Detection Consultant Prj.Mgr.: Ck1Y'%S DcN1qt'5 0 ❑ ❑ o 0 Limits Consultant Phone#: 1�p"i 7Q-3S(v�i116-172-3735 ❑Chromatograms Fax#: ) m -0 13 0 0 V... �. n Sampler: 1Se t ?? 'U o o g a Cl 'f5 7 N N O m m m U - Q Z m � � cn Field Repeat Top Time Ivew � o cro _ _ _ °° Point Name Matrix Sample Depth Year Month Day Collected Field PtYrN 0 U r° m a F- � Comments 1 Remarks o5e '5.1e,, tit Cle"t;? Vh w— S i.J Ar ©Ca O K o^^w '7 o i N IO w r VV 0& 05-04 1-4w D X Turnaround Time R uested[TAT](check box) Relinquishe Date Ti eceived by: Date Time STD.TAT ❑24 hour ❑48 hour ❑ 5 day ❑72 hour El4 day Relin ' ed by: Date Time Received by: Date Time Matrix Values Repeat Values Relinquished by: Date Time Received by: a Time S Soil D Duplicate sample r W Surface Water or Groundwater T Triplicate Sample Relinquished by Commercial Carrier: Received by: Pate Time T Trip Blank-QA Sample N Pre-Purge Sample UPS PgrExD OthertB R Rinsate Blank-OA Sample P Post-Purge Sample f (p M Miscellaneous(e.g.,product sample) Temperature/pH Upon Receipt 9160 C° pH Cu y als Int No Lancaster Laboratories,Inc.,2425 New Holland Pike,PO Box 12425,Lancaster,PA 17605-2425 (717)656-2300 4324.01 Rev.1/14/05 Copies:White and yellow should accompany samples to Lancaster Laboratories. The pink copy should be retained by the client.