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Historical Pipeline ' • <br /> +bmaster 0338 For La aster Laboratories use only <br /> Mwe quaftyisasderc• Acct.#: H12? Group# Sample#: <br /> Please print 1 Analyses Requested SCR#: <br /> Site/Global ID: U -t-j Preservation Codes Preservative Codes <br /> Site Address: H=HCf T=Thiosulfate. <br /> N=HNO3 B=NaOH <br /> ChevronTexaoo PM:M.Scott Mansholt Lead Consultant:SAIC d S=H2SO4 O=Other <br /> ` U <br /> Consultant/Office: E3 401 Alberto Way,Suite B,Los Gatos,CA 95432 c� ❑J value reporting needed <br /> A800 Watt Avenue,Suite 214,Sacramento,CA 95821 c ❑ , z <br /> ❑HPP Risk Assessment Detection <br /> o Limits <br /> Consultant Pr.Mgr.: © <br /> '7tt ��� ���� p cc o o ❑Chromatograms <br /> Consultant Pho ,� _ / !7/Fax#: ° 2 0 0 0 <br /> Sampler: r A-i' �i � v� W o M M <br /> _ o Z C14 00 N s3 Un U) U <br /> rZ m co 0 0 m —J <br /> Field Repeat Top Time Hew 0 �, m = 00_ _ <br /> Point Name Matrix Sam le Depth Year Month Day Collected Field Pt Yea c7 U m a <br /> p Comments!Remarks <br /> KA W-Z A440 or <br /> sy6 le SA ceii AtW <br /> Turnaround Time Requested[TAT]{check box} Relinquished by: Date Time iv by: Date Time <br /> ZIOf 23 <br /> W-STD.TAT ❑ 24 hour ❑48 hour <br /> ❑ 5 day ❑ 72 hour ❑4 day Re n uished by: a Time Receiv Time <br /> Matrix Values Repeat Values a ate Time to Time <br /> S Soil D Duplicate sample Relinquished by Commercial Carrier: Received by: Date Time <br /> W Surface Water or Groundwater T Triplicate Sample �6, <br /> T Trip Blank-QA Sample N Pre-Purge Sample UPS FedEx er l�C_ �Jv <br /> R Rinsate Blank-QA Sample P Post-Purge Sample <br /> M Kseelianeous(e.g.,product sample) Temperature/pH Upon Receipt OAC'C° pH Custody als ntact? es No <br /> Lancaster Laboratories,Inc.,2425 New Holland Pike,PO Box 12425,Lancaster,PA 17605-2425 {717}656-2300 4324.01 Rev.1/14105 <br /> Copies:White and yellow should accompany samples to Lancaster Laboratories. The pink copy should be retained by the client. f t� 3 <br />