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Donald Deari <br />Sampling Request <br />Date Recue <br />RECEI'v, <br />: 11/2/2016 o:Pp 0 9 2017 <br />Send Results To: Donald _Dearing, CC's Phone: 35509 <br />❑ Normal Sampling ❑ G&A (Overhead Account) or ❑ Oth laW NMENTAL <br />F]Special Projects Sample ID (s): (WDR / Q number or unique Project #: DEPARTME <br />identifier. If no WDR provide description and <br />❑ IGD Verification bldg. number.) Task #: <br />❑ New IGD GAC#1-W356453, GAC#2-W356456 Form Code: <br />IGD#: <br />0z144 .X21 .0 <br />TAT: ® Normal <br />❑ Rush <br />thai�uns�a <br />❑ Potentially Radioactive CC Approval: <br />❑ Sample may contain Beryllium <br />❑ HF or Ammonium Bifluoride a % - <br />❑ HCl @? -'o RCA Approval (mitia[D„e) <br />Off-site Analysis (Certified): <br />❑ Anions <br />❑ <br />DUST <br />❑ 608 <br />❑ <br />DLISTTCLP <br />❑ 624 <br />❑ <br />FLIST <br />❑ 625 <br />❑ <br />FLISTTCLP <br />® 8260 Total <br />❑ <br />PCBs <br />❑ TCLP 8260 <br />❑ <br />Oil and Grease <br />❑ 8270 Total <br />❑ <br />TPH gas <br />1 ❑ TCLP 8270 <br />❑ <br />TPH oil/diesel <br />❑ WVORG <br />❑ <br />Total Cyanide <br />❑ Other Analysis: <br />On-site Analysis (Non -certified): <br />❑ pH/N ❑ Carbon-14 <br />❑ Radscreen ❑ XRF <br />❑ Rad Dec ❑ Peroxide Strip <br />❑ Field Gamma ❑ Oxidizer Strip <br />❑ Fish Toxicity <br />❑ Flash Point <br />❑ Percent H -,O <br />❑ Explosives <br />❑ TATB <br />❑ TTLC Metals <br />❑ STLC Metals <br />❑ TCLP Metals <br />❑ Beryllium only <br />❑ <br />Hydrometer <br />❑ <br />Specific Gravity <br />❑ <br />Liquefaction <br />❑ <br />Other Analysis: <br />Date Sampled: <br />Logbook Entry:_ <br />Comments: <br />❑ Potassium only <br />❑ HEX Chrome <br />❑ GAB <br />❑ Tritium <br />❑ Gamma Spec. <br />❑ TUPA <br />❑ Curium <br />❑ Carbon-14 <br />❑ Sr -90 or Tc-99 <br />❑ Paint Filter ❑ Flash Point <br />❑ Solubility ❑ Boiling Point <br />❑ SCO Swipe & Survey <br />Time Sampled: <br />COC#: V I ----- -- - -- <br />2 125mil samples of GAC for VOC's analysis. <br />Beta/Gamma (cpm) = Beta/Gamma BKG (cpm) = Alpha (cpm) = Alpha BGK (cpm) _ <br />Container Activity (Ci) = Sample Activity (uCi) = Total Sample Volume (ml) _ <br />Sample Activity Concentration (uCi/ml) _ <br />WCG OW9 Effective Date 12/16/15 <br />See WIC 111 Expiration Date* 12/16/18 <br />TH <br />