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�JVL& , I , - J <br />r YY..Am , <br />FEB 0 9 2017 <br />Sampling Request ENVIRONMENTAL HEALTH <br />P g q GEPl�FtTNiENT <br />Re uestor: Alexander Blane-Zimberg <br />Date Requested: 11/21/16 <br />Send Results To: Hector Pedemonte / Alexander Blane-Zimber <br />Phone: 22549 <br />® Normal Sampling <br />® G&A (Overhead Accounl) or <br />❑ Other Client: <br />❑ Special Projects <br />❑ IGD Verification <br />❑ New IGD <br />Project #: <br />Task #: <br />Sample ID (s): (WMR / Q number or unique <br />identifier. If no WDR provide description and <br />bldg. number) <br />W356456 Q (5ozgoq 8 <br />Form Code: W310 <br />IGD#: 02149.111.0 <br />F] Potentially Radioactive <br />❑ Sample may contain Beryllium <br />❑ HF or Ammonium Bifluoride @ <br />F1 HCl @ % <br />CC Approval: pnitinlpate) <br />TAT: ® Normal <br />RCA Approval: OnaiaUDate) <br />❑ Rush <br />❑ Percent H2O <br />❑ GAB <br />Off-site <br />Analysis (Certified): <br />❑ pH/N <br />❑ <br />❑ <br />Anions <br />❑ DUST <br />® Fish Toxicity <br />❑ Potassium only <br />❑ <br />608 <br />❑ DLISTTCLP <br />❑ Flash Point <br />❑ HEX Chrome <br />❑ <br />624 <br />❑ FLIST <br />❑ Percent H2O <br />❑ GAB <br />❑ <br />625 <br />❑ FLISTTCLP <br />❑ Explosives <br />❑ Tritium <br />❑ <br />8260 Total <br />❑ PCBs <br />❑ TATB <br />❑ Gamma Spec. <br />❑ <br />TCLP 8260 <br />❑ Oil and Grease <br />❑ TTLC Metals <br />❑ TUPA <br />❑ <br />8270 Total <br />❑ TPH gas <br />❑ STLC Metals <br />❑ Curium <br />❑ <br />TCLP 8270 <br />❑ TPH oil/diesel <br />❑ TCLP Metals <br />❑ Carbon-14 <br />❑ <br />WVORG <br />❑ Total Cyanide <br />❑ Beryllium only <br />❑ Sr -90 or Tc-99 <br />❑ <br />Other Analysis: <br />On-site Analysis (Non -certified): <br />❑ pH/N <br />❑ <br />Carbon-14 <br />❑ Hydrometer ❑ Paint Filter ❑ Flash Point <br />❑ Radscreen <br />❑ <br />XRF <br />❑ Specific Gravity ❑ Solubility ❑ Boiling Point <br />❑ Rad Dee <br />❑ <br />Peroxide Strip <br />❑ Liquefaction ❑ SCO Swipe & Survey <br />❑ Field Gamma <br />❑ <br />Oxidizer Strip <br />❑ Other Analysis: <br />Date Sampled <br />11/17/16 <br />Logbook Entry: D V- / t <br />Comments; <br />Time Sampled: 10:30am <br />COC#: �_Q 6 1 -7 <br />GAC from 834 <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: 12116/15 <br />See WIC 111 Expiration Date: 12/16118 <br />