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v <br /> EAS Waste- Requesto <br /> III A roved <br /> Rus <br /> 19401288 S <br /> EAS Sample# --Date S ed <br /> Acct# I Date S / <br /> Building 8 9 Room ?Yes Q No C3 Date le <br /> Botties S 1VI Field Tech <br /> Send results to: L,- <br /> Comments: 640M 2 AS <br /> — <br /> ' <br /> (Record volume of liquid in onk wkm s=Wje4 NOT m=mm opacay of WAW <br /> O Retention Tank liters Tank# Q Tuff tank_Umrs(g:3 ) <br /> Carboy, Q 55 er <br /> Process/souzce genwating t6eFsampir, <br /> (Check ad t app l <br /> ® Aqueous Q Coolant- (specify below) Q Soil <br /> Q Base- (specify below) Q Solvents- (specify below) Q Sludge,solid <br /> Q Acid- (specify below) Q Oil- (specify below) Q Ph -0 <br /> er- (specify below) Q Silicon O UNKNOWN <br /> liquid p 96(by volume) Top/Bottom(circle one) ru IM <br /> Composition(L'st all other componena such asalcohol) oom <br /> ANAI I CESTE13 M tscttss wtt nvtro A yst assig tot area) <br /> Gene An lusts3KLAUAI= GC An QQ AnB <br /> O pHINormaiity ross Alpha and Bern* O and Q Volatiles <br /> ® Anions ritium* Aro Vo O Semi-Voladles <br /> ® gpm oil Specauscopy Q Non-halogenated Vols TCLP <br /> Q %oil *If only askag for alphaibeta or Q PCBs Q Voladles <br /> Q Cyanide 3H.fall out a Limiud Q 77M Q Semi-Volatfles <br /> Q Flashpoint Radioisotope Certification form <br /> Me It An iycss <br /> Q nIC NUMis O TTLC As Q TTLC Se Q TTLC Hg <br /> Q STLC Metals Q STLC As Q STLC Se Q STLC Hg <br /> Q T/+CLLP�/'Metals Q T [�Asw /ate /a 'tom Q TCLP <br /> L Se Q TCLP Hg <br /> 777 I C ®Ag.Ba.Be.Cd.Co.Cr1 Cu.Mn.Mo.Nee Pb.Sale TI.V'Za <br /> TCLP Metals-Ag.Ba.Cd.Cr.Pb <br /> Other Analyses <br /> 1 certify that the above ' n is ear complete to the best of my knowledge <br /> Gen Si L- Date <br /> Generata N (print) T / Ext 4®Z(pager) G_*/ 6A <br /> EAS Approval 1 Date <br /> EAS Approval 2 (for RTs) Date <br /> Rev 11.721/93 pme EL AP Cadftuion No. 1554 EAS(510)424-4127 <br />