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Historicial Pipeline Porfiblid AnolysisRequestlChoin of Custody <br /> LC xaster Lab25 j� For Lancaster Laboratories use only —7n 2 <br /> [M1erec tyisa5CA'<e 2230 Acct.#: ! �3 Group#�1 a �P r Sample#: 5� I `1 �.J <br /> Please print Analyses Requested SCR#: <br /> SitelGlobal ID: °In — {{ Preservation Codes Preservative Codes <br /> Site Address: �� �el� �J�� , Ut� �i ,C H=HCI T=Thiosulfate <br /> S� N=HNO3 B=NaOH <br /> ChevronTexaco PM:M.Scottoansbolt Lead Cos Ita t:Sq�C d S=H2SO4 O=Other <br /> 13� Li{o�1WoiY`�t � f <br /> Consultant/Office: tL,m�„-�. .�,^n m ni <br /> ,,�� c ❑J value reporting needed <br /> ❑3800 Waft Avenue,,Suite 210,Sacramento,CA 95821 c ❑ W z �FiPP Risk Assessment Detection <br /> Consultant Prj.Mgr.: �V[` �4 `t4 � ❑ ❑ _ Limits <br /> � � ❑ a v <br /> o N o o a ❑Chromatograms <br /> _63 X 0 <br /> Consultant Phone* <br /> Fax#: a`) m c � 0 0 oEl <br /> u, <br /> Sampler: °1'1 �� �t°l� SC+�r(II y CD M 0 0 CD <br /> N co coo U'> U U <br /> Z c <br /> d co O O C J <br /> Field Repeat Top Time Now E B m = _ _ _ <br /> Point Name Matrix Sample Depth Year Month Day Collected Field Pt YIN c7 H m 2 a a a <br /> —'3C .5 204- —2 0 f Or 1 'K Comments!Remarks <br /> 0 3 ' 2n-I1-21 010-) Y I X X k Ir s <br /> Mr Y <br /> %-32- _ 2 -�! _� j x k <br /> Turnaround Time Requested(TAT)(check box) Relinquished by: Date Time Received by: Date Time <br /> NSTD. TAT El24 hour ❑48 hour IYZIfftr 17DO <br /> ❑ 5 day ❑ 72 hour ❑ 4 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 by Commercial Carrier: Received ate Time <br /> W Surface Water or Groundwater T Triplicate Sampled,2 <br /> T Trip Blank-GA Sample N Pre-Purge Sample UPS FedEx Other <br /> R Rinsate Blank-GA Sample P Post-Purge Sample <br /> M Miscellaneous(e.g..product sample) TemperaturelpH Upon Receipt-5—,-7 Co pH Custody eats Intact? es 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 />