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EAS Waste-AnalysisRequest Form- <br /> A RUSHby <br /> IIII�III��I�IIIIIaIII�IIIaIII�NIIII — <br /> EAS Sample# <br /> 9401923 wAA Start <br /> D S <br /> Acct, S <br /> =ined <br /> Building1k.azzRoom ?Yes13 No ;t DateCompk ��2 � <br /> Bottles Submitted Field T w <br /> S7-, LXode end is to: .� — <br /> Comments: r P, <br /> SAMPLE (Record volume of l/grdd w=e in=k wise NOT mmimm capacuy of <br /> ® Retention Tank liters,Tank . O Tuff tank®liters(1 ga1.-3 ) <br /> Carboy,13 O 55 pL Drum, E3 dier <br /> Process/Source ' g the Ie 7�lJ.v� tr n urt L <br /> SAMPLE DESCRIMON 7ftecl MTM app ) <br /> O Aqueous O Coolant- (specify below) WSoiI <br /> O Base- (specify below) O Solvents- (specify below) O Sludge.solid <br /> O Acid- (specify below) O Oil- (specify below) O Photochemicals <br /> O Other- (specify below) O Silicon fluid O UNKNOWN <br /> O 2 liquid phases %(by volume) Top/Bottom(circle one) <br /> Composition(List all other components such as r,alcohol) <br /> INXEYSES RE tscuss wit intro A yst assig to M area) <br /> General Anal GC Am = GC-MS Ana <br /> ® pIVNormafity G ss Alpha and Beta* O Halo and O Volatiles <br /> O Anions T 'tium* Aro Volatiles O Semi-Volatiles <br /> O ppm oil S O Non-halogenated Vols &Iunim <br /> O %oil *If only askng for alphdbeta or O PCBs O Volatiles <br /> O Cyanide 3H.fill out a Limited O TPHs ®Semi-Volatiles <br /> O Flashpoint Radioisotope Cerokation form <br /> es <br /> O TTLC Metals O TTLC As O TrLC Se O TTLC Hg <br /> O STLC Metals O STLC As O STLC Se O STLC Hg <br /> �O� TCLP Metals O TnCLPv,As O T �P S.ye� �/ �p� O TCLP Hg <br /> i n Ag,Bas Be,Cd.Co.Cr.Cu.Mn.Mo.Nes Pb.JYs ++s ,Za <br /> -Ag,Ba.Cd.Cr.Pb <br /> Other Analyses <br /> I certify that the above intf9 tion is co ct ar lore to the best of my knowledge <br /> Gen Si L- ®D C- L2: <br /> Generator N (print) Lie <br /> EAS Approval 1 Date _7 / <br /> EAS Appmval 2(for RTs) Date <br /> Rev 11.7/21193 pme ELAP Cafifkadw No. 1554 FAS(510)424-4127 <br />