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TO 5105403157 FFZOM H`X–AC�Ll�TIC PAf�IC T 837 P �i { 5t�{ t?,+ <br />Sample <br />Container <br />' <br />State of Gilfania-CsiHomis EslvitooM ul Ikoaerim AaancY <br />of Toida Stibo"Mw Control <br />e. ;YPo f. Sias _ <br />HAZARDOUS MATERIALS f. Authorization Number <br />HMI. =b ; �:_ 2:: <br />SAMPLF—ANALYSIS REQUESTN M ><h 9 6 6 <br />ry <br />8 <br />a. Requsetaat A 1 Air J : 4. Phone (q A )�5-S .36 2 <br />S. Priority 1 . " ®: 3 <br />C <br />Address (To Receive 5esults):/01, C!&' , ""'*7,'"-f, 3 SArds CA 'TT6 17 <br />a. 'Authodtodby <br />-_ <br />D <br />8. Date Sampled 7. 71me Sampled Hours <br />S. Codes Wit in all applicable iodea} <br />._ <br />E <br />a. STC t? Q p• , <br />-- <br />F <br />S. Activity: SEB ❑ Sms ❑ FPB E]FMB ❑ NO ❑ OTHER <br />— <br />b. Region 0 <br />10. SAMPLING LOCATION <br />c. INDEX (Q L t p <br />12. ANALYSIS REQUESTED <br />a. EPA ID No. <br />d, PCA-� a. d <br />? A) " L �� Atc PA.a c. �S <br />e. MPC O C} f1 3 -7 <br />g C7 V0A-H/S <br />m.❑ CI -Pes- <br />b. Site <br />ticides <br />b. 0? atal <br />h. VOA -8240 <br />f. SITE / ,n f f 1,11A <br />"" Scan <br />c. Address &00 e seo CL4 k" FSC.J,,, <br />FNea+bK str.et Cite <br />11. SAMPLES <br />is, CHCUSTODY/ ` <br />ter' <br />C. <br />d. <br />16. LAR REMARKS: <br />OT3C 1 i16 (REVA/94) <br />(Fwmery OHS e0= <br />prapinal-t.sb • oupliuts-Fiis • Tripliaate-It to <br />aid Information <br />F <br />I <br />S <br />Hazardous Materials <br />ey <br />WNW +� <br />California Department of <br />Toxic Substances Control <br />Sample <br />Container <br />a. ID b. Collector's No. <br />c. Lab No. <br />d. Type <br />e. ;YPo f. Sias _ <br />A <br />8 <br />C <br />-_ <br />D <br />._ <br />E <br />-- <br />F <br />— <br />H <br />12. ANALYSIS REQUESTED <br />f. ❑ VOA -8020 <br />1• ❑ FOam <br />a. 9315H <br />g C7 V0A-H/S <br />m.❑ CI -Pes- <br />ticides <br />b. 0? atal <br />h. VOA -8240 <br />n.-C)OP-Pea- <br />"" Scan <br />ticides <br />C. ❑ Metals <br />i. (] VOA -826O <br />0. C] . <br />(Spec) <br />d. ❑ W.E.T. <br />j. [] SVO-8270 <br />P. ❑ <br />e. A-9010 <br />Diesel/ <br />k ❑ Gasoline <br />v. ❑ <br />13. SPECIAL REMARKS: <br />is, CHCUSTODY/ ` <br />ter' <br />C. <br />d. <br />16. LAR REMARKS: <br />OT3C 1 i16 (REVA/94) <br />(Fwmery OHS e0= <br />prapinal-t.sb • oupliuts-Fiis • Tripliaate-It to <br />aid Information <br />F <br />I <br />S <br />Hazardous Materials <br />ey <br />WNW +� <br />California Department of <br />Toxic Substances Control <br />