Laserfiche WebLink
- nth-,6,s alt. 4-cov•>n�t._,_�,,,�,n,a�L.ti3r� P,.,u�•, �B �G t�f <br /> I RTMENT OF FISH AND GAME <br /> Fish and Wildlife Water Pollution Control Laboratory— <br /> Request for Laboratory Analysis <br /> Your attention to completion of this form will allow WPCL chemish and biologists to better serve you.If you hove questions regordirsp any aspect of sampling or the results <br /> reported here,please call the appropriate number listed below.Also,it possible•please notify WPCL prior to arrival of samples.biology Lob(916)3350856;Chemistry <br /> Lab(916)355-0794,ATSS 438.XXXX. <br /> Delivered By: D.E. DeAnda 11170 Warden For Laboratory Use Only: <br /> Analysis Required: __Bioassay X Chemical WPCL Number L-482-90 <br /> Check for oil/oil byproducts/grease Other Number <br /> Date Required: Region 2 Field Number <br /> Send Results To: - Received By Bill Castle <br /> Name D.E. DeAnda # 170 11/28/90 <br /> Date Received <br /> Agency Fish and Game 12/14/90 <br /> Dote Completed <br /> Address F.O. Box 30803 <br /> City Stockton, CA ZIP 95213 916 355 7040 <br /> Phone( ) — <br /> Copies To. <br /> Problem Description(pollutant,source,water color,odor,etc.):_ Discharge from storm drain - nom par ing of <br /> .cleaning area - mark hlark in color - chunky/tan - petroleum/diesel smell <br /> Water Temp. 44(F�r°C(circle one) pH 6 Dissolved Oxygen y mg/L(ppm) <br /> Sample Sources(provide diagram below): Collected - sludge at outfall/field - soil samples at <br /> bottom of ditch - water sample with oil film. <br /> Sample Dexription(include number and size of containers): <br /> X Pollutant 2 samples 250 mL lass - refri erated - sample number 01 and #2 <br /> X Water I sample 250 ml. lass - refrigerated - sample number <br /> X Soil 2 _samples 250 mL glass - refrigerated - sample number <br /> Animal <br /> Animals were alive ,dying_,or dead when collected(Check one). <br /> Suspect Sample May Contain: Analysis Requested for the Following Reason: <br /> Heavy metals Fish and/or wildlife loss(Date of loss •Region_) <br /> X Petroleum products X DFG Code violation(Code Section -567— ) <br /> Fertilizer X Suspected or potential problem(explain below) <br /> X Other(gecify) Cooking grease _ Routine check <br /> Unknown <br /> AU MMUMNASIM On"TE AND NOT TO SCALE UNIESS STATED (SCALE= .y ) <br /> cr- <br /> " INDICATE <br /> 1 \, -ve ll NORTH <br /> �I�Min,ar�*1� hof' 'SnmP�i�� <br /> LIg <br /> 2N-> <br /> N <br /> �rt�4v} <br /> 3" <br /> 161a9a(Rev.4/e3) es 23575 <br />