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Histoficol Pipeline i • • • AnolysisRequestlChoinofCustody <br /> L-anOister LabOratoyles 2 2 2 9 kk For Lancaster Laboratories use only � �� pp+'�1 <br /> Kix gtlalityisasciertee GLC Acct.#: 1 Groupfl n�Q lQ Sample#: `! '77 G — <br /> Please print Analyses Requested SCR#: <br /> Site/Global ID: — Preservation Codes Preservative Codes <br /> Site Address: 22ilr276 W, Y2 CL N= HNO3 B=NaOH <br /> Ifate <br /> ChevronTexaco PM:M.Scot Mansholt Lead Consult nt:SAIC } 5= H2SO4 O=Other <br /> Consultant/Office:)K J c t ❑J value reporting needed <br /> El38�00�Wo venue,(Suite 210,,Sacramento,CA 95821 = L PP Risk Assessment Detection <br /> its <br /> Consultant Prj.Mgr.: y" r 1 I�L��I!1 V ❑ <br /> —� o El ❑Chromatograms <br /> L <br /> Consultant Phone#: !!J ;5 Fax#: 55 o <br /> Sampler: -�'}1��I�a m � cc <br /> 0 Z co o <br /> Field Repeat Top Time New m o o w = coPoint Name Matrix Sample Depth Year Month Day Collected Field RY1N 0 U m a <br /> Comments t Remarks <br /> I <br /> I Turnaround Time Requested(TAT)(check box) Re' uished by � ,� Date Time Received by: Date Time <br /> STD.TAT ❑ 24 hour ❑ 48 hour <br /> ❑ 5 day ❑72 hour ❑ 4 day a inqu' d by: Date Time Received by: Date Time <br /> I <br /> i <br /> Matrix Values Repeat Values <br /> Relinquished by: Date Time Received by: Date Time <br /> S Soil D Duplicate sample Relinquished b ercial Carrier: Received at 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 RinsateBlank-QA Sample P Post-Purge Sample <br /> M Miscellaneous(e.g.,product sample) Temperaturelp on Receipt pH Custody Seals Intact. es o <br /> Lancaster Laboratories,Inc.,2425 New Holland Pike,PO Box 12425,Lancaster,PA 17605-2425 (717)656-2300 4324.01 Rev. 1/14/05 <br /> Copies:White and yellow should accompany samples to Lancaster Laboratories. The pink copy should be retained by the client. <br />