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L&xaster LaW&des '8 8 O ) For Lancaster Laboratories use only Q 1 j <br /> Acct.#: ! 3 Group# a �� _Sample#: �P 9 7 yt — <br /> Please print Analyses Requested SCRM <br /> Site/Global ID: •-)TOMPreservation Codes Preservative Codes <br /> H=HCI T=Thiosulfate <br /> Site Address: �1111_7kz N =HNO3 B=NaOH <br /> ChevronTexaco PM: !. � m�ead Consultant: AIC �j/ L <br /> S=H2SO4 O=Other <br /> Consult antl0ffice:�+o`�i-Fdbe:i .a„"u: Qom_ QtQR 0 ^' VC]jve reporting needed <br /> co <br /> El3800 Waatt Avenue,Suite 210,Sacramento,CA 95821 Elv, zRisk Assessment Detection <br /> Consultant Pd.Mgr.: }rts i '� �1 y/ U ❑ 0 > w Limits <br /> ❑ p U <br /> ❑ <br /> o �, o o Chromatograms <br /> Consultant Phone#: ] X—( 5�7,6�� Fax#::� J�,C�I'LQ 0 0 0 0 <br /> Sampler: 1�/ �li C���&� t= N o o Q <br /> to 3 m U <br /> o Z CO O N y <br /> Q co O co <br /> O O J <br /> Field Repeat Top Time New 2 o o m = = _ <br /> Point Name Matrix Sample Depth Year Month Day Collected Field Pcvrlu C7 U m a <br /> 20 - — v � ) Comments!Remarks <br /> rXI Ki KI I <br /> ,� � ��� <br /> d Ivy v <br /> Turnaround Time Requested(TAT)(check box) Relir� he Date Time Ric!ived by: Date Time <br /> TD.TAT ❑ 24 hour ❑48 hour 7 <br /> 5 day El 72 hour El 4 day in ish_ y: Date Time Received by: "'� b� Date Time <br /> Matrix Values Repeat Values Relinquished by: Date Time Received by: e , Time <br /> S Soil D Duplicate sample Relinquished mmercial Carrier: Re eived by: Dae Time <br /> W Surface Water or Groundwater T Triplicate Sample f �y1 r� <br /> T Trip Blank-QA Sample N Pre-Purge Sample UPS FedE Other J *v V <br /> R R€nsate Blank-QA Sample P Post-Purge Sample <br /> M Miscellaneous(e.g..product sample) [Temperature/pH Upon Receip,2.3-S't' C. pH Custcuy Seals Intact? Ye 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 />