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pL. '-7. crjuc. .3 • r_.or res Ln r+ L 1 JL — nV41, r 11V- 0'40 r. 1l G <br />Deparime,Rt o. Toxic. Substances Controf SUPPLEMENTAL <br />0 <br />Hazardow Matertais Laboratory tca.dc,rsVPp.M.1+m1Aacu." <br />AUTHORIZATION REQUEST FORM (ARF) <br />P . T A : (By Requestor- PI -FRSE PRINT) <br />TAT Level <br />metais'scan (6010 <br />Imetaxs) <br />Requestor's Name <br />(cheep one) <br />Phone <br />specific <br />RegiontUnit <br />r s -X'lr PAX <br />( /� <br />S"f�� ^ 38 Q� <br />BACKUP RE4t1ESTOR /1:,,5 YZI, <br />,b �f® Phone <br />H <br />SITE: — --ate C. <br />a� �'-• _ S®I07.1171pA.S <br />AAVX�°' <br />PART B: Analytical Requests (By Requestat) (Lab uses default methods listed below. ALL other requests please specitvi <br />Marganic Analysis <br />Number of Samptestiyps <br />salla Uquid Water. Other <br />metais'scan (6010 <br />Imetaxs) <br />specific <br />WET <br />H <br />2 <br />cyanides <br />tavrols,*mis 3n1 <br />Iataerl: ,wr/41n! <br />TCL? Analysis <br />{sae fooftmfes) <br />,• <br />im+Irn n.euaaro) <br />fft1Mp TagxMw st <br />Metals <br />Merwry <br />Valatifes <br />uz`flt"ni)rClattlP.S <br />1aew.. wloenrt <br />Number of SarttpksnWe . <br />Organic Analysis said uquid water cow <br />CL -Pest (B081) <br />OP -Pest (8141) <br />PCSS 1382 <br />G R D .8n -S -B-. <br />'R T?/ MotaF D'tl L8� <br />n -Hexane Fxtraetables 1664. <br />Hash Point (1.0M <br />O'CS lrl W*V exec (8260) <br />SVOC.'s (BVD) <br />PAHS 8271a} <br />tames. *000 in) <br />A+rralysis Objective- =Ot4nkfng x o standards tapprwa in ow only) =Trasttnant Standards lap" anwyaaa s I.—, ane) <br />(check box) t# -18 Characterization =PRG9 .others (90"Oka Lab supemmeam it -sea") <br />Detection Limit Requiretnerits: (mom be Shawn on SAR arso) <br />txpaci4 A cornact Lab supervleats) <br />Expected Date ofS4rnpieArrival at4.ati i 1 i_2 IT <br />3_ ®-.�-2= <br />PART C . (By S O, - HML) <br />A41ho>•ization Number (AN) Lh h7 19 1513 1 -0 <br />Lab to Receive Sample(s) .. Name: Hazardous Materials Lab <br />Address: 700 Heinz -Ste, Ste. 150 <br />Berkeley, CA 94710 <br />sample Tracking Of#icer (sTOj <br />Today's Date: t I� i� _ It �_ b i Z- Expiration Date 1 <br />ARF's <br />)Ralrislon oto. <br />i" <br />Check bi1X if canctailed <br />�2 d e-2- <br />TAT L" . It- Ze 19- 30 days 3" 34 - AS days < - wban Pam <br />—rct.p : t rune patraft and/or sample matrix roe is appropriate Lab may. padarm a TTLC or wreaeior teat as the sampte(g rust In dstarmfrtt it TCLP is needed <br />PAHN by 5340 (Lq ,and STEX by 9021 (GOP10) may prock= laver QL& for Home movicas. Oft W,4L mefs rrranuW lM OL same-ri fans) =':R <br />