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EAS Waste-Aualysis Request Fo <br /> I�I�� �IIII�IIII�II�IIII�� <br /> Arm- <br /> 0pproved <br /> Rus <br /> 9401920 WAA SM Date <br /> EAS Sample# ate Sam <br /> nisi ' ME <br /> Ac cL Date S -� <br /> B ' ' < R # A?Yes® No ® Date <br /> Bottles Submitted n <br /> Send is to: ''? , S N r <br /> Co - C `U' <br /> (Record Volum of Hqwd waste M Wsk wkm swpieA NOT mmimm capacity of <br /> a Retention Tank-litem Tank# a Tufftank-liters(I gadm 3AQ <br /> ® Carboy, a 55 gal.Drtun, ACMer <br /> MceWbotzrce generating the le <br /> SAMP ION(MEE 0 dhwxaPP ) <br /> ® Aqueous O Coo - (specify below) iiffuid-�Lg)'e, <br /> ® Base- (specify below) ® Solvents- (specify below) solid <br /> ® Acid- (specify below) O Oil- (specify below) 17 Photochemicals <br /> ® Other- (specify below) ® Silicon 0 UNKNOWN <br /> Q 2.liquid pba m _%(by volume) Too/Bo (circle one) <br /> m <br /> ori v-conenes such-7:he taw,laquer thbiner,alcohol) <br /> ANALYM tscusa wu A ysr MgM to r-9 area) <br /> General An in= GC An Xses GC-MS Anal <br /> Pte® ss Alpha Beta* ® and O VoLatiles <br /> ® Anions ti * Vo ®Semi-Vo <br /> ® ppm oil S O Non-halogenatedVols TCLP 'cet <br /> ® %oil only for alphdbeta or ® PCBs ®Vo ' <br /> ® Cyanide 3H.fall out a Limited Q ITM ®scmi-Voladles <br /> Q Flashpoint Radioisotope Cert#kationfonn <br /> es <br /> ® MC Meals ® TMC As ® TMC Sc O TTLC Hg <br /> Q STLC Meals Q STLC As ® STLC Se ® STLC Hg <br /> ry® T 13 T (�,A/se,� Cr.Cu.Mn.'/� 13 TCL2 Sc g� ® TCLP Hg <br /> LMCA ALBr aA/ga,Ba_.Be,Cd.Co.Cr `uMnMo.NL Pb.Sb. ii' ♦,Z <br /> TCLP M s A&Ba,Cd.Cr.Pb <br /> Other AnalysCS <br /> I cerrify that the above infinrmation is correct iMd complete to the best of my knowledge <br /> Generator Signan Date <br /> Gener=Name(print) ` S ,�Eat) agcr) Uy zG g <br /> �—n <br /> EAS Approval l Date 77Z -r` Iff <br /> FAS Approval 2(for RTs) Date <br /> Rev 11.7121/93 tone ATw 7 66A A 0/!tM AAA AIM <br />