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DEC-03-2001 14:51 HAZARDOUS MATERAILS LAB 1 510 540 2305 P.02 <br /> =am ar umtornw ) b .ar.. ...p,. <br /> Califomla Environmental Protection Agency L 1 L 1-1—m.p( Hazardous Materials Laboratories <br /> HAZARDOU&-MATERIALS 1.Authorization Number iHML No. 2.Page <br /> SAMPLESISREQUEST To <br /> , <br /> . iar <br /> 1.RECIUESTO d 4124D �3-r.� � 0.Phone `/rq�C) � 7. TAT Level: (cheek one) <br /> 5.ADDRESS (To Receive Results) 6.FAX fj(q cE] ❑ L� l__J <br /> x7 ofz_ vl; <br /> 1 2 3 S <br /> Una Criers Signawre <br /> S.DATE S.Codes (l6 in all applicable codes) <br /> 10.ACTIVITY;(]SCO ❑ SRPO C 0113 ❑SMB ❑FPS ❑SPPT titan a.Office <br /> 11.SAMPLING LOCATION I I I b.INDEX Z4C)lq <br /> ^ a.EPA 10 Np, c.PCA <br /> b. Site �.-�l J J� {LOW k& L. d.MPC <br /> c. Address e.SITE <br /> Number Sbeet Gtr JP I.County <br /> 12.SAMPLES: Sample Cantainef <br /> •r. b.Collectat's No. c.HML Na. d.T e 11. yEd_ r.Size g. Field Infom tion <br /> A FVu z4l 0111 41 Cb <br /> 8 c <br /> D I la L <br /> ° F 3 <br /> F 1 <br /> 11.ANALYSIS REQUESTED: desired anaNsis and enter l.Os ham lZa. <br /> INORGANIC ANALYSIS sample(s) 10 ORGANIC ANALYSIS le s) 10 W—, <br /> H CL-Pesticides 8081 <br /> Metals Scan 6010) 1T7 CP-Pesticides 8141) <br /> Metal(s)Specific PCBs (8082) II <br /> WET G R 0 80150 <br /> C nld® D R 01 Motor Oil I Bath (rxie anal <br /> /Mari wde int n-HB a Estractables 1664) <br /> aalers.Mem) Flash Paint 1020 <br /> TCLP Analysis E VOCs Iticludin RTIX 8260 <br /> and if news co CLP leas VOCs-LO Level- 5 <br /> Metals VOCs-HI Level 8035 <br /> Mercury SVOCa 8270 <br /> Vdatlles PAHs 8270 <br /> Semwoladles <br /> ahem.wt7e int <br /> atners,carte int <br /> 14.ANALYSIS 084ECTrVE: aete Characterimdcn Truttnete SOnaards <br /> (crux a box) Lj Drinking H,C Standards (apbllea Ic 0W anh) Others raanact Lae.moervisas am) <br /> 16.DETECTION LIMIT REQUIREMENTS: <br /> mx+fv a k O ano'cantxt 120) <br /> 16.SUPPLEMENTAL Initials <br /> REQUESTS ' <br /> 17.LA6 REMAR Date �. <br /> a <br /> 1 CUT 4 <br /> to \� 6 l <br /> © to <br /> to <br /> d /���(y�/}y—y �— lYvonJb\A+ AStroOi¢Iid GG II IPI c l to C <br /> ,vane/.) / TNe .) luarve 48115,ole i <br /> /7=rO <br />