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Sampling Request �] <br />r'4, y, �- �� f �I <br />I <br />Vin.. ti <br />FEB 0 9 2017 <br />.V, hAr_f"rrAI t-cAITH <br />Re uestor: Alexander Blane-Zimberg <br />IYIll— y . "_" <br />Date Requested: 11 -- ` IZATME-NT <br />Send Results To: Hector Pedemonte / Alexander Blane-Zimber <br />Phone: 22549 <br />® Normal Sampling <br />❑ Special Projects <br />p <br />❑ IGD Verification <br />F] New IGD <br />® G&A (Overhead Acco(u:t) or <br />❑ Other Client: <br />Project #: <br />Task #: <br />Sample ID (s): (WDR / Q number or unique <br />identifier. If no WDR provide description and <br />bldg. number.) vJ <br />W353384 / <br />Form Code: W409 <br />IGD#: 00909 <br />rbu 2.�p q �� <br />❑ Potentially Radioactive <br />❑ Sample may contain Beryllium <br />CC Approval: (miliaBDwo <br />❑ FLIST <br />❑ HF or Ammonium Bifluoride @ % <br />❑ HCl @ % <br />❑ GAB <br />TAT: ® Normal <br />RCA Approval: (Inilint Da1c) <br />❑ Rush <br />❑ Tritium <br />❑ 8260 Total <br />Off-site Analysis (Certified): <br />❑ Anions <br />❑ DLIST <br />❑ Fish Toxicity <br />❑ Potassium only <br />❑ 608 <br />❑ DLISTTCLP <br />❑ Flash Point <br />❑ HEX Chrome <br />❑ 624 <br />❑ FLIST <br />❑ Percent H2O <br />❑ GAB <br />❑ 625 <br />❑ FLISTTCLP <br />❑ Explosives <br />❑ Tritium <br />❑ 8260 Total <br />❑ PCBs <br />❑ TATB <br />❑ Gamma Spec. <br />❑ TCLP 8260 <br />® Oil and Grease <br />® TTLC Metals <br />❑ TUPA <br />❑ 8270 Total <br />❑ TPH gas <br />® STLC Metals <br />❑ Curium <br />❑ TCLP 8270 <br />❑ TPH oil/diesel <br />® TCLP Metals <br />❑ Carbon-14 <br />❑ WVORG <br />❑ Total Cyanide <br />❑ Beryllium only <br />❑ Sr -90 or Tc-99 <br />❑ Other Analysis: <br />On-site Analysis (Non -certified): <br />❑ pH/N <br />❑ Carbon-14 <br />❑ <br />Hydrometer <br />❑ Paint Filter ❑ Flash Point <br />❑ Radscreen <br />❑ XRF <br />❑ <br />Specific Gravity <br />❑ Solubility ❑ Boiling Point <br />❑ Rad Dec <br />❑ Peroxide Strip <br />❑ <br />Liquefaction <br />❑ SCO Swipe & Survey <br />❑ Field Gamma <br />❑ Oxidizer Strip <br />❑ <br />Other Analysis: <br />Date Sampled: 11/17/16 <br />Logbook Entry: DV— 7 I S <br />Comments: <br />Time Sampled: 10:30am <br />COC#: Z �o 17 <br />W353384, solid debris (TTLC, STLC, TCLP & PPM OIL/Grease) <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 0009 Effective Date 12/16/15 <br />See WIC 111 Expiration Date 12/16/18 <br />