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+L'3w2S1Br L21�les For Lancaster Laboratories use only <br /> Ut�herequaftyisas irm 2 Acct.#: Group# 1 ZZ�� Sample#: 55Y 2--'3 <br /> b—�f <br /> Please print ] v I Analyses Requested SCR#: <br /> Site/Global ID: V�;6'4 k vlalq4l Preservation Codes Preservative Codes <br /> H=HCI T=Thiosulfate <br /> Site Address: i �. d I n N=HNO3 B=NaOH <br /> ChevronTexaoo PM:M.Scott an olt Lead Consults AIC d S=HzSO4 =Other <br /> 1 tDcC ,t.l�a7� �u '1ocr9ci� C�' <br /> Consultant/Ofiice:,93401 4 ` <br /> c� ❑J value reporting needed <br /> ❑3800 Watt y nue,Suite 210,Sacrart}ento,CA 95821 c a. PP Risk Assessment Detection <br /> j I 6 r�V✓� ❑ ❑ ❑ o imits <br /> Consultant Pd.Mgr.: rr p J w <br /> C7 1 6 7 Fax#: o © W ❑Chromatograms <br /> Consultant Phone#: L co <br /> N o 0 0 �, <br /> SampEer: <br /> Ike— N � � o o � � � a <br /> 0 Z m n <br /> d co o o <br /> Field Repeat Top Time Hew 2 F m , m = co <br /> Point Name Matrix Sample Depth Year Month Day Collected Field Pt YIN 0 01 vi <br /> m a <br /> Comments 1 Remarks <br /> Ix <br /> /136 fi <br /> ; round Time Requested (TAT](check box} Relinquis y: D to Time R eived by: Date G Time <br /> STD.TAT ❑ 24 hour ❑48 hour / s o <br /> ❑ 5 day ❑ 72 hour ❑4 day Rei wished by: Date TimeReceived-by: Date Time <br /> 126 <br /> Matrix Values Repeat Values Relinquished by: Date Time Received by: Date Time <br /> S Soil D Duplicate sample Relinquished by Commercial Carrier:. iv Date Time <br /> W Surface Water or Groundwater T Triplicate Sample Er <br /> T Trip Blank-QA Sample N Pre-Purge Sample UPS FedEx Other <br /> R Rinsate Blank-QA Sample P Post-Purge Sample XL'I'M <br /> M Miscellaneous(e.g.,product sample) Temperature/pH Upon Receipt 1,�2 C° pF! ustody Seals Intact. a 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 />