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EAS Waste--Analysis Request- Form <br /> 111111111111111111111913 RUSH <br /> Approved by <br /> EAS Sample# 9402233 WAA Start Dat <br /> Date Sampl <br /> HWM Requisition# Acct.# Date S <br /> Building# Room# ?-Yes 13 No Date Complete <br /> #Bottles S Feld Tech <br /> Send results to: UCode o <br /> Comments; <br /> w <br /> W <br /> SAMPLE <br /> (Rtcond 1+01mw of liquid wash in tank where <br /> sanepltd,NOT mauttttart capacity of talekl: <br /> 13 Retention Tank liters,Tank# . ❑ Tuff liters Q gal.=I&) ' <br /> ❑ Carboy, ❑55 gal. Drum, Other <br /> 131'CZ Ource generating the sampleo�D <br /> A (Check all dw apply) <br /> ❑ Aqueous ❑ Coolant- (specify below) <br /> ❑ Base- (specify below) ❑ Solvents- (specify below) Sludge,solid <br /> ❑ Acid- (specify below) ❑ Oil- (specify below) ❑ Photochemic als <br /> ❑ Other- (specify below) ❑ Silicon fluid ❑ UNKNOWN <br /> ❑ 2 liquid phases _.% (by volume) Top/Bottom(circle one) <br /> Composition(List all other components such as hexane,Laquer thinner,alcohol) <br /> (Discuss withEnvironmentai Analyst assigned to the arca <br /> General Analyses nalvsm GC Analyses GC-MS Analyses <br /> ❑ pH/Normality ~Alphaand Beta* ❑Halogenated and ❑Volatiles <br /> ❑ Anions tiiim* Aromatic Volatiles ❑Semi-Volatiles <br /> ❑ ppm oil <br /> 13 <br /> 13 Non-halogenated Vols 'pCLP C1rQarlics <br /> 13 %oil !f only ad ng for alpha/beta or ❑ PCBs ❑Volatiles <br /> ❑ <br /> Cyanide 3H,fill out a Limited ❑ TPHS ❑Semi-Volatiles <br /> ❑ Flashpoint Radioisotope Certification form <br /> Metals Analyte <br /> ❑ TTLC Metals ❑ TMC As ❑ TTLC Sc ❑ TMC Hg <br /> ❑ STLC Metals ❑ STLC As ❑ STLC Se ❑ STLC Hg <br /> ❑ TCLP Metals ❑ TCLP As ❑ TCLP Se ❑ TCLP Hg <br /> MC/STLC Metals Ag,Ba,Be,Cd,Co,Cr,Cu,Mn,Mo,Ni.Pb,Sb,Tl, V,Za <br /> TCLP Metals-Ag,Ba,Cd,Cr,Pb <br /> Other Analyses <br /> 1 certify that the above ' n is ect complete to the <br /> beesttof my knowled e <br /> Generator Signa L- <br /> Date li <br /> 71 <br /> Generator Name(print) �l (�(ON �— %pix Ext-3-Z 2Za lager) <br /> EAS Approval 1 Date <br /> EAS Approval 2 (for RTs) Date <br /> Rev 11, 7121/93 time EIAP rear irmtntinn Nn_ 1 SSA FAS(5101424-4127 <br />