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Histoncal Pipeline Poftfid Analysis RequestlChoin of Custody <br /> +L-a�r L""Q For Lancaster Laboratories use only <br /> tiNherequalltY as€ e Acct.#: � Group# 1 A 03973 Sample#:6 0\3 <br /> Please print Analyses Requested SCR#: <br /> Site/Global ID: Preservation Codes Preservative Codes <br /> H =HCl T=Thiosulfate <br /> Site Address: N=HNO3 B=NaOH <br /> ChevronTexaco PM: �y��, /Lead Co sullttant:S C � � y/ > S=H2SO4 O=Other <br /> T idCfrl7l ir✓L� '�/J c 1 � / �O/ -2 <br /> Consultant/Office: Los G 0 ❑J value reporting needed <br /> 3800 Watt Avenue,Suite 210,Sacrame CA 95821 c U a <br /> El 3800 HPP Risk Assessment Detection <br /> Consultant Pd.Mgr.: / til/ 0 ❑ ❑ [ = Limits <br /> U � <br /> - <br /> Lu U <br /> o N ❑ 0 o v ❑Chromatograms <br /> Consuitant Phone#: J Fax#: 0 CO CO <br /> Y -0 ❑ "' 0E c3 0 0 <br /> Sampler: f Zm N <br /> Field Repeat Top Time New o 9 w m x CO CO _ i5 <br /> o Point Name Matrix Sample Depth Year Month Day Collected Field Pt YIN 0 U F- m a F M <br /> Co eats 1 Remarks <br /> a ' <br /> 4 1-7 <br /> ......... <br /> 1N � ca S <br /> u X� <br /> d � 5 <br /> ✓'r AT <br /> jF5arouElElnd Time Requested(TAT)(check box) PReWfq`[_ishe_dby:eli hed Date Time Received b . Date Time <br /> D.TATEl24 hour El48 hour <br /> ay 72 hour 4 day Date Time RecRived by: Date Time <br /> Matrix Values Repeat Values Relinquished by: Date Time Receive by: Date Time <br /> S Soil D Duplicate sample Relinquished by Commercial Carrier: Received by: to Time <br /> W Surface Water or Groundwater T Triplicate Sample <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) TemperaturelpH Upon Receip pH -Lust 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.1114105 <br /> Copies:White and yellow should accompany samples to Lancaster Laboratories. The pink copy should be retained by the client. <br />