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Histotical Pipeline ' • 1 • AnolysisRequestlChainofCustody <br /> Lancaster UmtOnes 1047 For Lancaster Laboratories use only, ` <br /> Vvfi&egvalitydsascdenc . Acct.#: Group#i t O 55 4 Sample#: `�")L4 9a,3p -3 3 <br /> Please print Analyses Requested SCR#: <br /> Site/Global ID: 1 — Preservation Codes Preservative Codes <br /> p,7 f!� H =HCI T=Thiosulfate <br /> Site Address: Q N =HNO3 B=NaOH <br /> _ <br /> ChevronTexaco PM:M.Scott Mansholt Lead Consultant:SAIC m S=H2SO4 O=Other <br /> y U <br /> Consultant/Office: a, c� ❑J value reporting needed <br /> ayg�' HPP Risk Assessment Detection <br /> ❑3800 att Avenue,Suite 210,Sacramento, A95821 U imus <br /> Consultant Prj.Mgr.: r © J <br /> L O N 0 00 ❑Chromatograms <br /> Consultant Phone#: "' 76-5 Fax#: a`t m <br /> � v, o <br /> S C .�"/3 �. } ] ,( _ m E o o <br /> Sampler: !�7 oo <br /> 0 Z <br /> co <br /> Field Repeat Top Time New @ D a w i = <br /> Point Name Matrix Sample- Depth Year Month Day Collected Field t YIN 0 U. H m a � <br /> P <br /> a V7 �/ .i, Comments 1 Remarks <br /> C� 'kxf <br /> Turnaround Time Requested{TAT]{check box) <br /> Rel' uished`: Date Time Received by: Date Time <br /> XSTD.TAT El 24 hour El 48 hour I <br /> El 5 day El 72 hour El 4 day elin ed by: Date Time Received by: Date Time <br /> Matrix Values Repeat Values Relinquished by: Date Time Re ' ed by: ,� Date Time <br /> S Soil D Duplicate sample Relinquished by Commercial Carrier: ecei ' d y: Date Time <br /> W Surface Water or Groundwater T Triplicate Sample <br /> T Trip Blank-QA Sample N Pre-Purge Sample UPSe.Ex Other <br /> R Rinsate Blank-QA Sample P Post-Purge Sample <br /> M Miscellaneous(e.g.,product sample) Temperature/pH Upon Receipt t 1 4 C° pH Custo y Seals Intact? Aj <br /> No <br /> Lancaster Laboratories,Inc.,2425 New Holland Pike,PO Box 12425,Lancaster,PA 17605-2425 (717)656-2300 4324.01 Rev.1114/05 <br /> Copies:White and yellow should accompany samples to Lancaster Laboratories. The pink copy should be retained by the client. <br />