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Number Street City <br />12. SAMPLES: <br />a. ID b. Collector's No. c. HML No. <br />A <br />B <br />C <br />D <br />E <br />F <br />-- 13 ANALYSIS RE ^ <br />INORGANIC ANALYSIS <br />H <br />Metals Scan (6010} <br />ww'm <br />'CLP Analysis <br />QUESTED: <br />__IL Sampfefs} ID <br />WIN <br />Z1P ,5�Tg,:2�LC <br />Sample Co <br />d. Type <br />� e. Twe <br />P/lar! I %d << <br />and enter I.Ds from 1 <br />OP -Pesticides (8141) <br />PCBs .(8082) <br />G k O (8015B) <br />D R O / Motor Oil f Both (cfrrie ones <br />PAHs <br />ANALYSIS OBJECTIVE: <br />UfTwaste Characterization <br />(check a box) Drinking HZO Standards (apprres to DW only) <br />DETECTION LIMIT REQUIREMENTS: <br />so R lwown and contact i— <br />SUPPLEMENTAL <br />REQUESTS <br />-P-5 REMARKS: <br />Treatment Standards <br />Others (contact Lab supervisors first) <br />/c <br />Initials <br />Date <br />:H�- CUSTODY: <br />P 1/l /�.f' fT 1�5 iz ►>, a to <br />I I --- to <br />101 <br />Sianafure(s) Names) /Title (s) I to 1 <br />111fiH n.?Ft/amm <br />Inclusive Dates of Custody <br />lC Q <br />3 4 <br />8. DATE SAMPLED: <br />`of Calif�m[a <br />' Unit Chiefs Signature <br />10. ACTPA7 y: Q SCD <br />❑ SRPD ❑ ClB ❑ SMB ❑ FPB <br />❑ SPPT • ❑ Others <br />9. Codes (fill in all applicable codes) <br />a. Office 017, <br />�11. SAMPLING LOCATION G A L. C7 d d <br />9 <br />Califomia EnvironMen <br />I Pro <br />M <br />ction.A encu <br />TERIALS <br />1. Authorization Number <br />Department of Toxic Substances Control <br />Hazardous Materials Laboratories <br />HML No. Q�j�--i &-2. page <br />1AZARDO <br />SAMPLE ANA <br />SI <br />REQUEST <br />� l�C z <br />u <br />/f <br />4. phone (�/p) J`�d -3 �7� <br />To _ of <br />7. TAT Level: (check one) ` <br />3. REQUESTOR: <br />5. ADDRESS (To Rec <br />ive R <br />ufts) <br />6. FAX (jia Ssdv- <br />FP' E <br />Number Street City <br />12. SAMPLES: <br />a. ID b. Collector's No. c. HML No. <br />A <br />B <br />C <br />D <br />E <br />F <br />-- 13 ANALYSIS RE ^ <br />INORGANIC ANALYSIS <br />H <br />Metals Scan (6010} <br />ww'm <br />'CLP Analysis <br />QUESTED: <br />__IL Sampfefs} ID <br />WIN <br />Z1P ,5�Tg,:2�LC <br />Sample Co <br />d. Type <br />� e. Twe <br />P/lar! I %d << <br />and enter I.Ds from 1 <br />OP -Pesticides (8141) <br />PCBs .(8082) <br />G k O (8015B) <br />D R O / Motor Oil f Both (cfrrie ones <br />PAHs <br />ANALYSIS OBJECTIVE: <br />UfTwaste Characterization <br />(check a box) Drinking HZO Standards (apprres to DW only) <br />DETECTION LIMIT REQUIREMENTS: <br />so R lwown and contact i— <br />SUPPLEMENTAL <br />REQUESTS <br />-P-5 REMARKS: <br />Treatment Standards <br />Others (contact Lab supervisors first) <br />/c <br />Initials <br />Date <br />:H�- CUSTODY: <br />P 1/l /�.f' fT 1�5 iz ►>, a to <br />I I --- to <br />101 <br />Sianafure(s) Names) /Title (s) I to 1 <br />111fiH n.?Ft/amm <br />Inclusive Dates of Custody <br />lC Q <br />3 4 <br />8. DATE SAMPLED: <br />' Unit Chiefs Signature <br />10. ACTPA7 y: Q SCD <br />❑ SRPD ❑ ClB ❑ SMB ❑ FPB <br />❑ SPPT • ❑ Others <br />9. Codes (fill in all applicable codes) <br />a. Office 017, <br />�11. SAMPLING LOCATION G A L. C7 d d <br />9 <br />b. INDEX D <br />b. Site <br />a. EPA ID <br />11 ®I r� <br />No. <br />S 1,d. <br />c. PCA <br />c. Address <br />i��z �' Y"-7 <br />MPC <br />e. SITE <br />Number Street City <br />12. SAMPLES: <br />a. ID b. Collector's No. c. HML No. <br />A <br />B <br />C <br />D <br />E <br />F <br />-- 13 ANALYSIS RE ^ <br />INORGANIC ANALYSIS <br />H <br />Metals Scan (6010} <br />ww'm <br />'CLP Analysis <br />QUESTED: <br />__IL Sampfefs} ID <br />WIN <br />Z1P ,5�Tg,:2�LC <br />Sample Co <br />d. Type <br />� e. Twe <br />P/lar! I %d << <br />and enter I.Ds from 1 <br />OP -Pesticides (8141) <br />PCBs .(8082) <br />G k O (8015B) <br />D R O / Motor Oil f Both (cfrrie ones <br />PAHs <br />ANALYSIS OBJECTIVE: <br />UfTwaste Characterization <br />(check a box) Drinking HZO Standards (apprres to DW only) <br />DETECTION LIMIT REQUIREMENTS: <br />so R lwown and contact i— <br />SUPPLEMENTAL <br />REQUESTS <br />-P-5 REMARKS: <br />Treatment Standards <br />Others (contact Lab supervisors first) <br />/c <br />Initials <br />Date <br />:H�- CUSTODY: <br />P 1/l /�.f' fT 1�5 iz ►>, a to <br />I I --- to <br />101 <br />Sianafure(s) Names) /Title (s) I to 1 <br />111fiH n.?Ft/amm <br />Inclusive Dates of Custody <br />