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Historical Pipeline Porfiblid Analysis RequestlChain of Custody Lancaster LabOraWeSFor Lancaster laboratories use only 1N✓�et tityisascknce• ! Acct.#: 1141 Group#) l DO-7 7S Sample#: 55 y c]o �-7—3? Please print Analyses Requested SCR#: Site/Global ID: Kd Preservation Codes Preservative Codes 1 00 M=HCI T=Thiosulfate Site Address: �T �' . 1 y N=HNO3 B= NaOH ChevronTexaco PM:M.Scott�r anshollt Lead nsultant: IC m S= 1-12504 O=Other cn ConsultantlOffice: ® c 0 � ` ❑J value reporting needed 113800 Watt�Ave))n}}ue,Suite 210,Sacramento,CA 95821 0 , z HPP Risk Assessment Detection Consultant Prj.Mgr.: \;A/, !I =J ftp v✓�Iti U ❑ ❑ � o Limits O N �, ❑ 0 0 ❑Chromatograms Er Consultant Phone#: Fax#: a W ❑ i 0 0 0 Sampler: ,>�! y o „�. p Z m o;� NCL Lu Field Repeat Top Time Z m E w m = _ _ Lu Point Name Matrix Sample Depth Year Month Day Collected FIeIdPtYIN (D U m a a ,�. Comments I Remarks -r �� - �5�" Cx 1 .r t, " 5 Turnaround Time Requested (TAT)(check box) Reli ed by: Date Time Received Date Time STD.TAT ❑ 24 hour ❑ 48 hour !2V 00 El 5 day El 72 hour El 4 day q sh Date Time Received by: Date Time Matrix Values Repeat Values Relinquished by: Date Time eceiv d y: _Date Time S Soil D Duplicate sample Relinquished by Commercial Carrier: Receiv d b Dat Time W Surface Water or Groundwater T Triplicate Sample I T Trip Blank-QA Sample N Pre-Purge Sample UPS _' Othert 1 1Ej7 R Rinsate Blank-QA Sample P Post-Purge Sample 'k Y:�� M M Miscellaneous(e.g.,product sample) Temperature/pH Upon Receipt -3�-Z> Co pH Custo Seals Intact? No Lancaster Laboratories, Inc.,2425 New Holland Pike,PO Box 12425,Lancaster, PA 17605-2425 (717)656-2300 4324.01 Rev. 1114105 Copies:White and yellow should accompany samples to Lancaster Laboratories. The pink copy should be retained by the client.