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Hearaous M—eu ws Labonuory <br /> HAZARDOUS MATERIALS 1.Authorization Number HMLNo-6311 <br /> S fv/S/ . >'.-�! V.=•: Sw"4-7.7c.tyZ rta..lT.. . S. . y <br /> 2t Page. <br /> SAMPLE ANALYSIS REQUEST H M �, t 1 . <br /> o at <br /> 4.Phone Ntc) rrJ"3.Requestor: }/e.t c_ <br /> Addres (To Receive Rewtts):/� StS ZIZed biW . <br /> 6. Date Sampled J7L t/S L T Time Sampled . Hours-' -- ILCodes (fig in:all.applicableoodesl: ..� <br /> 9.Activity: Q8EB ❑SMB ❑FPB. t. ❑ATD ❑PASD•. .❑Otfwe• _-� <br /> Q - b:Region <br /> 10:SAMPLING LOCATION- J4 D` 'L - C 3 6 .g Y' •'� y `• : o_TPG• • . ,. ^_ <br /> .. <br /> as•..,:.:: n] a a.EPA•1ONm 'd'PIDE . <br /> sR. Le c1; iCl F7'aL ?EcN <br /> e.PCA <br /> c.AddressCW L g• <br /> 11.SAMPLES at. <br /> . Sample Container. <br /> a.ID b.Collectors No. a Lab No:. _ &-Type 61 Type— Y.sva - <br /> g.Feld;fr;for nation <br /> A LMry 7.71- ( h!!.�— 21A 1.3. L{. <br /> g tWT4L7l� LQ JL..+Cyl larr <br /> C- C>"w l V 7-71- 7 dC::/ F. <br /> D . ..-._. _ . ..- - -- <br /> l ' <br /> E E <br /> F L <br /> 12-ANALYSIS REQUESTED f. ❑PCB k•❑ Ext Org •'- •- <br /> a..[XpH g.❑ VOA+I/S L❑ Flash <br /> Pow <br /> b.E4 Metal h.❑ VOA-8240 m• ❑ <br /> Scan <br /> G E9 Metals 9 i.❑ VOA-8260 n•❑ <br /> _.__ (Spec)_ ._.._. _. .. __._._,._...- <br /> d.❑W.E-T. j• ❑ SVO-8270 0•0 <br /> '13.SUPPLEMENTAL <br /> REQUESTS - <br /> .�. .° <br /> ate&k ... <br /> ' <br /> 14. CHTOrS7DD - z#L <br /> b. <br /> d. <br /> 15.SPECIAL REMARKS: - - - <br /> 16.ASSIGNED TO: Date <br /> 17.LAB REMARKS: L <br /> A <br /> B <br /> DHS 8002(Rev 76.90) Original-Lab - Dup6cate-File • Tnpii=te-1nspecum .., NLYMM•). <br />