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Histodcal ' ' Analysis RequiestlChain / Custody <br /> Lw-asw Lbordles 0648 For La aster Laboratories use only <br /> Mwe qLdfyuascier�. Acct.#: Group# Sample <br /> Please print Analyses Requested SCR#: <br /> Site/Global ID- Preservation Codes Preservative Codes <br /> Site Address: ;S45 <br /> ;L W'd:h7R <br /> r Mjy�.y►t gs,C H=HCI T=Thiosulfate <br /> N= HNO3 B=NaOH <br /> ChevronTexaoo PM:M.Scott Mansholt Lead Consultant:SAIC d 5=H2SO4 O=Other <br /> In U <br /> Consultantl0ffice: El 401 Alberto Way,Suite B,Los Gatos,CA 95032 c� ^' ❑J value reporting needed <br /> 'm 1 ig a <br /> 3800 Watt Avenue,Suite 210,Sacramento,CA 958210 ❑ rn z ElHPP Risk Assessment Detection <br /> Consultant Prj.Mgr.: U45 ��,� U <br /> El � o Limits <br /> p 2 , o N N0 0 ❑Chromatograms <br /> Consultant Phone#: ���� (�(�' Fax#: �k jtd� `3 � a) <br /> A © 0 o o 00 M <br /> i� E <br /> Sampler: sJ��1 m 3 co N 2 < <br /> cc <br /> Field Repeat Top Time New o 6 w m = = = w <br /> Point Name Matrix Sample Depth Year Month Day Collected Flew PCYM C9 U I° m a F P � M <br /> lj N U 3 Comments!Remarks 77 <br /> NIP, c 3f� X clean-up a* <br /> V4rJ A 4 X050 C7 e4.� MOO U miK- <br /> F W— I V�! N 001057/_&3 t <br /> rt A NbeyQq N l o <br /> Turnaround Time Requested(TAT)(check box) hed by: Date Time eived by: [}ate Time <br /> >STD.TAT El 24 hour El 48 hour <br /> 5 .a <br /> ❑ 5 day El72 hour El4 day Rein � b . 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 by Commercial Carrier: Received ate Time <br /> W Surface Water or Groundwater T Triplicate Sample <br /> T Trip Blank-QA Sample N Pre-Purge Sample UPS ed E Other <br /> R Rinsate Blank-QA Sample P Post-Purge Sample <br /> M Miscellaneous(e.g.,product sample) Temperature/pH Upon Receipt Co pH C o act? es No <br /> Lancaster Laboratories, Inc.,2425 New Holland Pike,PO Box 12425,Lancaster,PA 17605-2425 (717)656-2300 4324.01 Rev. 1114105 <br /> Copies:White and yellow should accompany samples to Lancaster Laboratories. The pink copy should be retained by the client. <br />