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EAS W e-Anaivsis Reqnest Form <br /> Illl�lf Approved RU <br /> ��I� a9laaaaa <br /> 9 4 0 2 218 WAA S v ®� <br /> EAS Sample Date S <br /> HWM Requis n# Acct. 1& 3-4 - Date S ;26 <br /> q y <br /> Building Room ?Yes 0 No ® Dane Comp <br /> Bottles S Field Tech <br /> Send results to: L_ rMEN <br /> Comments- - -v i- /- <br /> ru <br /> ru am <br /> W <br /> A (Record voolumw of Hquw w=in wAwn MrwieAL NOT <br /> O Re tion T _UM T . O T li <br /> tas O SS ;& et (1 ms13JAP) <br /> s/S® g the 1 t <br /> A <br /> ❑ Aoueous D Coolant- (specify below) D Soil <br /> D Base - (specify below) D Solvents- (specify below) D Sludge.solid <br /> Acid- (specify below) 0 Oil- (specify below) ❑ Phowchernicals <br /> Other (specify below) D Silicon fluid D UNKNOWN <br /> 4md p %(by volume) Top/Bo (circle one) <br /> Composition(L.4t 1 other components such as ,alcohol) <br /> �MXEYS <br /> rscrtss aysro Analyst assignedtot area <br /> General An lv� G n es GC-MS Anah„ <br /> ❑ pH/No Alpha Beta* O and D Volatiles <br /> ❑ Anions T tum* Ammatic Volaxiles D Semi-voladks <br /> ❑ ppm oiIi�,.4 Sp D Non-halogenatedVols T <br /> C3 %oil If only asidng for*h&baa or D PCBS D Voladles <br /> ❑ Cyanide 3N,fill our a Limiwd D TTYHs ❑Semi-Vo <br /> ❑ Fiashpoint Radioisotope Cemficxwnfonn <br /> ❑ TILC Memis D TMC As O TMC Se O TMCHg <br /> ❑ STLC Metals ❑ STLC As O STLC Se O STLC Hg <br /> TMC/TMCO TC LP Metals p O TLPe Ass �a� y�� 3 T �P Spey �p O TCLPHg <br /> =Age Ba.Be.DCd.CO.Cr.Cu. Mo.NL Pb.Sb. 1 ,zo <br /> M -A&Ba.Cd.Cr.Pb <br /> Other Analyses_ <br /> I certify that the above inP n is co cr complete to the best of my brow <br /> Generator Si L- ^2 Date <br /> Gen Name(print) 1 ; " G v , Ext ( (pager)CX <br /> EAS Approval 1 Date <br /> EAS Approval 2 (for RTs) Date <br /> Rev 11.7/21/93 n me PT.AP rPr9iAf 2ti#%n Pj#% 9 ecA cs a eclm AIA-tt7! <br />