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Historical Pon1blid Analysis RequestlChoin of Custody <br /> LaxaAff 1212 1 For Lancaster Laboratories use only <br /> K4i9egA9kyisaxierxe. Acct.#: 13Group# 10 7� �3� Sample#: 52075-Yl-5q7 <br /> Please print Analyses Requested SCR#: <br /> SitelGlobal ID: ca '5L66011 q 7 L) Preservation Codes Preservative Codes <br /> Site Address: 9'2--7 5 ljil i�'y f i Vp� �%j �} H=HCl T=Thiosulfate <br /> co <br /> CL <br /> N=H NO3 B=NaOH <br /> ChevronTexaco PM:M.Scott Mansholt Lead Consultant:SAIC m S=H2SO4 O=Other <br /> �A U <br /> Consultant/Office: ❑401 Alberto Way,Suite B,Los Gatos,CA 95032 cz ❑J value reporting needed <br /> 3800 Watt Avenue,Suite 210,Sacramento,CA 85821 c �, z El HPP Risk Assessment Detection <br /> o Limits <br /> Consultant Pd.Mgr.: f1c /�kA �C_ ❑ ❑ �+! n <br /> Consultant Phone* 5j' 0 'q&&— 7/78 FF ° W "' ❑ c��s ❑Chromatograms <br /> r f Fax q&_�a- j �73e y � � <br /> Sampler f.�i't�I3 G �� SM� y � N � � cal <br /> z co CO N r %2 <br /> Q co CD Cp O N <br /> Field Repeat Top Time New m o o , m = x s x <br /> Lu <br /> Point Name Matrix Sample Depth Year Month Day Collected Field Pt YM C9 U H m a <br /> '- — Comments I Remar s <br /> D 29 S (15t j;r y� clr <br /> JA) 09 2-7A) � a4 r?, d( <br /> 0 6 dwiw <br /> ��rr Mhh <br /> M ot �' <br /> Turnaround Time Requested(TAT)(check box) Rel?V5 #Dte <br /> T d Received by: Date Time <br /> STD.TAT El 24 hour El 48 hour <br /> El day El 72 hour El day Relinquished by: Time Received by: Date Time <br /> Matrix Values Repeat Values Relinquished by: Date Time Received Date Time <br /> S Soil D Duplicate sample Relinquished mercial Carrier: Rece by: Date Ti�1e�� <br /> W Surface Water or Groundwater T Triplicate Sample 'e• <br /> T Trip Blank-4A Sample N Pre-Purge Sample UPS edEx Other 2—�'C7$ 10 3C <br /> R Rn sate Blank-4A Sample P Post-Purge Sample <br /> M Miscellaneous(e.g..product sample) Temperature/pH Upon Receipt 1.3' C° pH Custody 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.1/14/05 <br /> Copies:White and yellow should accompany samples to Lancaster Laboratories. The pink copy should be retained by the cllent. <br />