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EAS Request Fbrm- <br /> D RUSH <br /> IApprovedWAA Start: <br /> EAS S 9401289 T32te S <br /> HWM ReqWsition# Acct.# =Diie S - <br /> #13® � g s Room# R ?Yes D No R Dam <br /> Send to: T4 ubmitted _Z T L <br /> Co ts+ p .. _ - <br /> t cls3 6 <br /> 11 <br /> rd vvimm OfUqvid wam in tan&wins s=Wie4N0Tnw==capacuyaf wW <br /> ® Retention Tank li Q T li (1 3 <br /> CI Carboy, R SS ®tom P►L<<✓' <br /> ® g the ie <br /> SAMPLE Jul <br /> ( t aPPIY) <br /> R Aqueous ® Cbolam- (specify below) R Soil <br /> R Base• (specify below) Q Solvents- (specify below) R Sludge,solid <br /> (specify below) R Oil- <br /> (specify below) a Photochemicalsr <br /> (specify below) R Silicon R UNKNOWN PEM <br /> liquid P (by volume) Top Con(List <br /> all other compone=such as hcmw,Laquer thinner,alcohol) <br /> M jr <br /> A (07M wII'ftEnviromnen=Anaiysr assignea to the area) <br /> GC Analyses GC-MS Anal <br /> R pIVN® ss Alpha and B * R and R Volatilm <br /> R Anions iroirnVo Semi-Voladja <br /> o <br /> R ppm oil Ipecco D Non-halogenated Vols TMI <br /> R ° oil •fonly foraipha/b=or <br /> R PCBs R Volatiles <br /> R Cyanide 3H.fill out a Limiwd R 77M R Se=-Volmilm <br /> ® Flashpoint Radiodorope Cerng7c=n form <br /> ® TIZC Metals R 'ITEC As R TTLC Se R TrLCHg <br /> R STLC Metals R STLC As R STLC Se R STLC Hg <br /> X13 T/eQ�L2/s A o QD TCLPe,AsCrCu.Mn. '`� ® T L S�}ey ® TCLP g <br /> .�l rL1.gI,J`i L6.. =Ag.Bae..Be. <br /> ` d.Co.WCrA CMnMo.NL Pb,Sb.TI.V,Za .. <br /> i CLC iii i Ag,B'.Cd.C.["N <br /> Other Analyses <br /> I certify that the above info nucorrecrandlerezozhebesrqfmyIawwIedge <br /> Gen Si L- Dane <br /> Generator N (print) AI <br /> EAS Appmvai 1 Dam <br /> EAS Appmvai 2 (for RTs) Date <br /> _-1 <br /> Rev 11. 7/21/9' "me FLAP('Astvfiravinn Mn t 44d FAS aSIM 424-4147 <br />