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• 1JLL . 7. LrJCJC. J - C. -Yr 14 '.�rl L I JC. - 1711"l1'Ir <br />Ahtzv_ otio r. 11 a <br />Deparknent of Ttudc Substances Control SUPPLEMENTAL <br />Hazardous Matefrats Laboratory (Check if Swppiemmmi Pea�.eq <br />AUTHORIZATION REQUEST FOR (ARF) <br />P _ T A : (By Requestor- Pi FASE PRINT) <br />TAT Level: <br />Metals Scant (601D) <br />(check we) et <br />2 <br />3 4 <br />Requestol's Name <br />Phone <br />(S10)'s�D <br />-.3gis <br />Region/Unit Aole, <br />7- ES, •S - FAX <br />Q -/o) <br />f jf z7 38 Q! <br />y <br />BACK-11FRErQUESTejtc ��;s F','•,C <br />f t� b�� .erg• Phone <br />�QZLZ�.) <br />S'ie& <br />SITE: iv,�— �' <br />i�r2 ., 7�; •Sp �v �'`�a v s <br />AM <br />e° <br />foilivI -mm-vr <br />CPART 9,. Analytical Requests - (By Requestar) (tab uses default methods [rated below, ALL other reqursfs please seecttvl i <br />Inorganic Analysis <br />Number of Samptasir j pa <br />Soud Uquid water, Other <br />Metals Scant (601D) <br />Metal(s) Specific: <br />WET i <br />Q <br />it anides <br />toat.a.voAe in) <br />t*6i•art:.AUa/ Int <br />TGLP Analysis <br />{sec footnotes) <br />e° <br />foilivI -mm-vr <br />tttoTCl Mvirmsso <br />Metals <br />MercurL <br />�fa.(ati(es <br />Seivollatiles <br />logo". *memo <br />Number of Samp)eslJy.Pe <br />Organic Analysis said Liquid watef Other <br />CL -Pest (8081) <br />OP -Pest (8141) <br />PCas 082' <br />G R O . BDZB. <br />R 'Df Motor oil L 81i; <br />n-i-iexane Fxt'ractabies 1664 <br />Flash Point (1.020) <br />VACS (8260) <br />SVO'Cs (8Zf0) <br />PAYS 827% <br />roma.-r�.m) <br />3wfie Hon . <br />toe*, vests int <br />Arr81y5i5 Ot9jeGt(1/e: =Artnking H2O Standards favorers to taw only) <br />(check box) [E tW eta Characteftation PRGs <br />Detection Limit Requirements: ' (must be shtmn on SAR also) <br />(specify b *mast Lab supewlsms) <br />=Trtntmeet Standards (specify analyse • I•••I m.nml <br />=Others faattaaLab supamsoaB•osoea) <br />Expected Date of Sample Arrival at A ab ; 2 XT <br />PART C : (8y sTo - HML) <br />Aythotizatien Number (AN) N 1 f I I � 9'f 15.1,31 <br />Lab to Receive Sample(s) . blame: Hazardous Materials Lab <br />Address: 700 Heinz Ste, Ste. 150 <br />Berkeley, CA 94710 <br />Sample Tracking Officer (STO) m err <br />Today's Date: r t' r_( r_ b t Z Expiration Date l <br />I- wb .L w.-� 3 1 <br />ARF's <br />Arerslcn iQo. <br />Check box if cancelled <br />TAT ravel: 'I- 10.16 dpya (requkm uatr*Nor: ai®mwva an SRR) 2- Iff- 30 days 3- 31. a64wa ® - when paeslbte <br />"rCLP : If /Ane permila and/or sample matriz typo Is apprWiate Lah may pedarm a TTLC or acreMinS teat on the sample(a) rust to determine it TCLP is needed. <br />PAtis by $310 (LC) and STEX by BOT/ (GC(PID) may produca waw QI.s for gems matrices. (Soo HAItL usaes lienuai For OL aamparfseaa) MR <br />