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EAS Waste--Analysis Request Form Aft <br /> IMEIIIIIIIIIIIIII RUsx <br /> Approved by <br /> 9402218 WAA Start D <br /> EAS Sample# Date Sampl <br /> HWM Requis' i n# Acct. # !6 5�I - � � Date Su <br /> Building Room# RMMA?Yes❑ No ❑ Date Co <br /> #Bottles Submitted Field Tech <br /> �� <br /> Send results to: — L-Code <br /> r <br /> Comments' � o <br /> ru <br /> ru <br /> SAMPLED3 <br /> (Record volume of liquid waste in tank when sampled.NOT manmuvtt capacity of t=k) <br /> ❑ Retention Tank liters, Tank# ❑ Tuff tank liters(I gal.=3JQ <br /> ❑ Carboy, ❑ 55 gaL Ilium, R-Other <br /> Process/Source generating the sample 77-71,777 <br /> SAMPLE ( c t app ) <br /> ❑ Aqueous ❑ Coolant- (specify below) ❑ Soil <br /> ❑ Base - (specify below) ❑ Solvents- (specify below) ❑ Sludge, solid <br /> Acid- (specify below) ❑ Oil- (specify below) ❑ Photochemicals <br /> Other (specify below) ❑ Silicon fluid ❑ UNKNOWN <br /> ❑ 2"Lq id phases % (by volume) Top/Bottom(circle one) <br /> ( such Composition ' t 1 other components ch as hexane, laquer thinner,alcohol) <br /> XNALYSES IR tsuswEnvironmental <br /> Analyst assigned to the area) <br /> General Analyses C Analyses GC-MS Analy,= <br /> C3rm <br /> pH/Noaliry r�bLssAlpha and Beta* ❑Halogenated and ❑Volatiles <br /> ❑ Anions Aromatic Volatiles ❑ Semi-Volatiles <br /> ❑ ppm oil p�o�py ❑ Non-halogenated Vols TCLP Organics <br /> ❑ % Oil fony asking for alphalbeta or ❑ PCBs ❑ Volatiles <br /> ❑ Cyanide 3H,fill our a L,itnirrd ❑ TPHs ❑ Semi-Volatiles <br /> ❑ Flashpoint Radioisotope Certi 5cation form <br /> ❑ TTLC Metals ❑ TTLC As ❑ TMC Se ❑ TTLC Hg <br /> ❑ STLC Metals ❑ STLC As ❑ STLC Sc ❑ STLC Hg <br /> ❑ TCLP Metals ❑ TCLP As ❑ TCLP Se ❑ TCLP Hg <br /> T LCISTI-C Metals = Ag, Ba, Be,Cd,Co.Cr,Cu,Mn,Mo.Ni,Pb, Sb,Tl, V, Zn <br /> TCLP Metals= Ag.Ba,Cd,Cr.Pb <br /> Other Analyses_ <br /> I certify that the above ' r# on is corn cr mplere to the best of my knowled <br /> Generator Signanu / Date <br /> Generator Name / <br /> (P t) 1, Ext.- <br /> _112 (pager) _G <br /> EAS Approval 1 Date S <br /> EAS Approval 2 (for RTs) Date <br /> Rev 11, 721/93 me FT AP rpvtiF".r "... Nn 1 CCA c A C /<InN AIA-Al" <br />