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r <br /> +Law2derLabm"es 111886 1 j For Lancaster Laboratories use only Q <br /> WwequaGtyisaxkme. Acct.#: I Group#I t� Sample#:b 63 r 950 —S3 <br /> Please print Analyses Requested SCR#: <br /> Site/Global ID: Preservation Codes Preservative Codes <br /> Site Address: �y ¢ a H=HCl T=Thiosulfate <br /> N=HNO3 B= NaOH <br /> ChevronTexaco PM: ead Consultant:SAIC.. S=H2SO4 O=Other <br /> Consultant/Office01 id`certo "'a�. }a�+^ �tea - c� ^' Cval a reporting needed <br /> Risk Assessment Detection <br /> ❑3800 Watt Avenue,Suite 216,Sacramento,CA 95821 o v, z <br /> Consultant Prj.Mgr.: - lJl�I�I � � /\ ❑ ❑ -' ❑Chromatograms <br /> N 7 <br /> C) � U U <br /> N <br /> Consultant Phone#: C Fax M senye mo <br /> 0 <br /> ❑ "' o 0 0 <br /> Sampler: c o <br /> O Z m r_ un un Lo U <br /> 0. co O O - J <br /> Field Repeat Top Time New m o o w _ _ _ _ ,< <br /> CL <br /> Point Name Matrix Sample Depth Year Month Day Collected Field Pt YIN <br /> x X Commen s 1 Remar s <br /> Turnaround Time Requested (TAT)(check box) Relinquished Date Time Rec ' d by: Date Time <br /> ;TD.TAT ❑ 24 hour ❑48 hour <br /> ❑ 5 day ❑ 72 hour 114 day Relinquished by: 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 b mercial Carrier: Rec ived by: Date Time <br /> W Surface Water or Groundwater T Triplicate Sample ���1� )r� <br /> T Trip Blank-QA Sample N Pre-Purge Sample UPS ed Ex Other V <br /> R Rinsate Blank-QA Sample P Post-Purge Sample <br /> M Miscellaneous(e.g.,product sample) TemperaturelpH Upon Receipt 'L3 C° pH Custody teals Intact? QYes No <br /> Lancaster Laboratories, Inc.,2425 New Holland Pike,PO Box 12425,Lancaster,PA 17605-2425 {797}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 />