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Slats of California P VM rv14(vo OOSI Department of Toxic Substances Control <br /> Words EnvironmentalENVIRONMENTAL CHEMISTRY LABORATORY. 1.Authorization Number ECL No.:&w 2 2. Page <br /> SAMPLE ANALYSIS REQUEST .dBEg9Ga:. To �eoQQS 1 of '1 <br /> 3.Requestor.(to Receive Results) a.Name: Anne Ekker 4.Project Name(if applicable): <br /> b,Address: 5796 Corporate Ave, (sliest mxMer) <br /> Cypress,CA 90630 <br /> (dty,slate,bp) . <br /> o.Phone: _(714)484-6309(wea code ruw) d,Fax; (714)4a4G496(ares code nm) &TAT Level; ', 2 <br /> e.Email:- anne,ekker _ @dtso.ca.gov <br /> 6.Sampling Information: a,DateMme Sampled:111128/16 (mm/dd(yy) 7,Codes(sew Rom drop doom tort or ml to R oppneebie) <br /> b,Location;EPA I D No. CAL000433517 (#;#k WPM) a.Unit xww-as�mcnmm,t l,r„ey,u�.tcyP„„) <br /> Site: - Thatcher Goof California,Stockton b.Project ID AFSCk08l11kLWCAO[SCilygy�. <br /> Address: 1010 Industrial Drive (sReetnamher} c.Activity ID 36195 . <br /> Stockton,CA 95206 (city,state,rip) d.MPC 962, 12j9 <br /> GPS-Let. GPS-Long: e.County 39–San Joaquin <br /> GPS-Alt; GPS-Depth: <br /> S,Samples: I.Number of <br /> a.ID b.'Collectors W. ¢.ECL No, d.Matrix e.Container Size containers g,Preservative/Field Information <br /> 1 TCS-O6 . �pdy$'� iWaa rb,,.ra,.a.l oz dear Ia r _1 Iicelsalitmt hypochbdle leaking from pipe <br /> fH t2j4jlb , <br /> 3 TCS-07 Oa884 u,,m,rro,.no,.a.,t6 oz deo a sjar 1 jke loaue5c malerlaVxasm rromm Maas caste <br /> fk* <br /> ti 14 t t8 <br /> s <br /> 7 !I! <br /> 6 i I i I <br /> I' <br /> g I <br /> g.,Analysis Requested; Enter sample IDs and sample ID ranges saps ad by commas.For exam le,1.3,5.7,9 F <br /> a.Inorganic Analysis Sample(s)ID b,Organic Analysis Samole(s)ID I <br /> FM yi It} E <br /> tW 12j4ji$ <br /> l <br /> i <br /> Outer Metals:, <br /> c.TCLP Analysis d.Other Analysis <br /> e.Comments for MWSphasic Samples/Analysis Priority: <br /> 10.Analysis Objscdve: Waste Classification ' <br /> 11.Detection Limit Requirements: . - <br /> 12.Supplemental Requests:Enter sample IDs as described in Item 9 13.ECL Lab Remarks: l <br /> Desired Analysis Sample s)ID E <br /> Initials � <br /> Date s <br /> 14.Chairrof Custody. <br /> Name -Title Signature IrAdusnre Dates of Custody <br /> b. n'G P r Io ( 2g <br /> d -- — 11)Nf1Q to toc <br /> to 6E;P <br /> L -- — to <br /> to <br /> 07.0146.00]ev0122s20f7_Approved by Qualky Management 0l6cer Make Photocopies for Your File <br />