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Histofical Pipeline Porffbifid Analysis RequestlChain of Custody *Lancaster Ltw&ries 1212 For Lancaster Laboratories use only wheregtJ441isascience Acct.#: Group# Sample N Ptease print Analyses Requested SCR#- SitelGlobat ID- +j k 4 Preservation Codes Preservative Codes Site Address: H =HCl T=Thiosu{fate = N=HNO3 B=NaOH Chevron Texaco PAA:lul.Scott Mansholt tea Consu#cant:SAIL 5= H2SO4 O=Other �1 Cj Cons ultanVOf ice: El 401 Alberto Way,Suite B.Los Gatos, CA 95032 r "' ❑i value reporting needed a L7 3800 Wats Avenue,Suite 210,Sacramento.CA 95821 ❑ ❑HPP Risk Assessment Detection Consultant Prf Eater-- U_ ❑ ❑ ? f`I o Limits u1/' N ❑ a 0 a ❑Chromatograms Consultant Phone#: PaxiK '7 i/• �': a`r m � :�- d 4 U Sampler' a �A,• 1 - y ❑ ❑ U o a 0 ¢ -4 04c a — m o4 c Field JRepeat Tap Time 1 New E ca >< w "' x s Point Name Matrix Sample Depth Year Month Cay Collected fined Ps YeN L) m a ___ __• Comments 1 Remarks Turnaround Time Requested (TAT)[check box] Relinquished by: Dale Time Received by. Date Time D STD. TAT G 24 hour !El 48 hour 5 day ❑ 72 hour ©4 day Relinquished by: mate Time Received by. Date Time Matrix Values Repeat Values Relinquished by: Date Tirne Received by: Dale Time S Solt 0 oliplieate sample vV Surface Water or Grounawater T Tnplicate Sample Refinquished by Commercial Carrier: Received by, Date Time T Trip Blank-DA sample N Prp.-Purge Sample UPS FedEx Other R RmsaW Blank-QA Sample P Post-Purge Sample — - — M ihlliscelfaneraiy[s-g-.product sample) TemperalurafpH Upon Receipt C' PH Custody Seals Intact? Yes No Lancaster Laboratories,Inc.,2425 New Holland Pike,PO Box 12425,Lancaster.PA 17605-2425 (717}656.2300 4324,01 Rev. 1114,05 Copies:White and yellow should accompany samples to Lancaster Laboratories. The pink copy should to retained by the client.