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1 aPI <br /> iP <br /> - efine Porffofid AnalysisRequestlChoih1 <br /> La l �� 1889 j For Lancaster Laboratories use only, T <br /> wi�erec rya as�ertce 3 Acct.#: + Group#a o q' 7�7 Sample#: 119V 3 a 3 a <br /> Please print Analyses Requested SCR#: <br /> Site/Global ID: yYa�i 00 Preservation Codes Preservative Codes <br /> y _ H=HCl T=Thiosulfate <br /> Site Address: / _ N=HNO3 B=NaOH <br /> ChevronTexaco PM: Lead suftant:SAIC d S=H2SO4 O=Other <br /> i ��ly r9 o��rc,G�9v <br /> 1r- r ❑J value reporting needed <br /> C©nsultantlOflfioe:� ar> ' � Q <br /> W a HPP Risk Assessment Detection <br /> ,a•— - ©-38AG Watt A1rOnm Gmi+a 91n CjQrwrA aCAg I'i (LSB 'ttrrrtts <br /> `II © © El o o D Consultant Pd.Mgr.: �I� <br /> ❑Chromatograms <br /> Consultant Phone#: — J "7 Fax#: I�Pi (D ° ao <br /> p Vn o a fl <br /> F o g a <br /> Sampler: TJp 4 N N ,�, � U, 0 <br /> QZ m 'C",-co V o c go 00 U) <br /> Field Repeat. Top Time Now o o w m _ a Lu <br /> Point Name Matrix Sample Depth Year Month Day Collected FiewPtYIN L) <br /> 3 1 a 1 Comments!Remarks <br /> Turnaround Time Requested(TAT)(check box) Relin Date Time Received by: Date Time <br /> TD.TAT El24 hour ❑48 hour <br /> ❑ 5 day El 72 hour El 4 day Relinquished by: b6to Time Receive by: Date Time <br /> Matrix Values Repeat Values Relinquished by: Date Time Received b Date Time <br /> S Soil D Duplicate sample Relinquished by Commercial Carrier. Received by: ate 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 c <br /> M Miscellaneous(e.g.,product sample) Temperature/pH Upon Receipt 7,`) C. pH y Seals Intact? es o <br /> 4324.01 Rev. 1/14105 <br /> Lancaster Laboratories,Inc.,2425 New Holland Pike,PO Box 12425,Lancaster,PA 17605-2425 (717)656-2300 <br /> Copies:White and yellow should accompany samples to Lancaster Laboratories. The pink copy should be retained by the client. <br />