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' A State of California <br /> DEPARTMENT OF FISH AND GAME <br /> Fish and Wildlife Water Pollution Control Laboratory <br /> Request for Laboratory Analysis <br /> Your attention to completion of this form will allow W PCL chemists and biologists to better serve you.If you have questions regarding any aspect of sampling or the result, <br /> reported here,please colt the appropriate number listed below.Also,if possible,please notify WPCL prior to arrival of samples.Biology Lob(916)355-0856;Chemistry <br /> Lab(916)355-0794;ATSS 438.XXXX. <br /> Delivered By: Warden John M. Stark <br /> FReceivedBy <br /> Only: <br /> Analysis Required: X BioassayL-211-85 <br /> R Chemical <br /> Date Required: 2 <br /> Region <br /> Send Results To: lliam T. Castle <br /> y <br /> Name John M. Stark 09-13-85 <br /> Date Received <br /> Agency Fish and Game 10-17-85 <br /> Address P. 0. Box 6294 Date Completed <br /> City Stockton, CA ZIP 95206 <br /> Phone(209 ) 462 _ 7438 <br /> Copies To. <br /> Problem Description(pollutant,source,water color,odor,etc.): Paint (red) <br /> Water Temp. °F or°C(circle one) pH Dissolved Oxygen <br /> Sample Sources(provide diagram below): <br /> Sample Description(include number and size of containers): <br /> X Pollutant 2 2 III 2 <br /> -- Water <br /> -- Soil <br /> — Animal <br /> Animals were alive ,dying_,or dead when collected(Check one). <br /> Suspect Sample May Contain: Analysis Requested for the Following Reason: <br /> — Heavy metals X Fish and/or wildlife loss(Date of loss ;Region 2 <br /> Petroleum products X ) <br /> DFG Code violation(Code Section ) <br /> XFertilizer <br /> — Other(specify) solvent _ Suspected or potential problem(explain below) <br /> X Unknown --- Routine check <br /> 1 1171111111 ill <br /> FALLMEASUREMENTS ARE APPROXIMATE AND NOT TO SCALE UNLESS:' 5 <br /> O <br /> INDICATE <br /> NORTH <br /> 2" <br /> ( <br /> 1" 2" 3" <br /> 3" 6" �. <br /> Ffteee(Rw.4/86) <br /> 85 35575 <br />