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+L"2stP-r Lab V 1 2234 For Lancaster Laboratories use only 1 �J <br /> 1Mterequa tyesas-d- re Acct.M L/13 Group# I/ � I laOa Sample#: ;S� 3 9I I I <br /> Please print Analyses Requested SCR#: <br /> Site/Global ID: 90-Ule Preservation Codes Preservative Codes <br /> Site Address: r a' if a H=HCf T=Thiosulfate <br /> 7 5 = N=HNO3 B=NaOH <br /> Chevron' exaco M:M.Sm M sholt ead Consultant:SA_II C �' 9 60 7 d S=H2SO4 O=Other <br /> Consultant/Office' ;' �'�Q^^�. l �a v6ieB �^ m c� ^' <br /> 3`' '� a ❑J value reporting needed <br /> ❑3800 Watt Avenue,Suite 210,Sacramento,CA 95821c � u, z HPP Risk Assessment Detection <br /> Limits <br /> Consultant Prj.Mgr.: <br /> a o o ❑ 00 0 El C h rom atog ra ms <br /> Consultant Phone#: Fax#: Q co m 0 <br /> -0 % ❑ w o o 00 <br /> Sampler: r 1 y N N <br /> p Z m m � uO Un <br /> CL co o o <br /> w m i = _ <br /> co <br /> Field Repeat Top Time rte, B 2 <br /> Point Name Matrix Sample Depth Year Month Day Collected Fleld Puna U CO 0- F- <br /> 04 — ' ✓ Comments J Remarks <br /> 5 -- 3 w — 3-5 1 1 toot? <br /> o 7 X1of <br /> `f -- ) fX 77 <br /> S61— 1,✓ — 1 21 k _71X <br /> Turnaround Time Requested{TAT){check box) Relinquish y: r Date Time Received by: Date Time <br /> STD.TAT El24 hour El48 hour �,MI <br /> El 5 day El 72 hour ❑4 day R q 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 mmercial Carrier: Receive Qat Time <br /> W Surface Water or Groundwater T Triplicate Sample !! G <br /> h�& <br /> T Trip Blank-GA Sample N Pre-Purge Sample UPS FedEx Other <br /> R Rinsate Blank-QA Sample P Post-Purge Sample <br /> M Miscellaneous(e.g..product sample) [Tem peraturelpH Upon Receipt a � pH Custody Seals Intact? ere!f 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 />