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RECEIVE® <br /> Sampling Request DEC 0 4 2015 <br /> —1 E�.1%MRQNk4U1 <br /> Re uestor: D. DEARING Date Requested: 11 16 SALTH DEPARTMEN <br /> Send Results To: D. KRAMER Phone: 3-9136 <br /> E Normal Sampling E G&A Overhead Account or ❑ Other Client: <br /> Sample ID(s): (WDR/Q number or unique <br /> F] Special Projects identifier. If no WDR provide description and Project#: <br /> ❑ IGD Verification bldg. number.) Task#: <br /> ❑ New IGD 874 Dus Bin, 874 Machine Area, 843 Outdoor Form Code: <br /> Work Area, 875 Machine Shop Area, 827B CC Approval: (W i.Mle) <br /> IGD#: Machine Shop. <br /> ❑ Potentially Radioactive <br /> TAT: ❑ Normal ❑ Sample may contain Beryllium RCA Approval: (tniti.vwte) <br /> ❑ Rush ❑ HF or Ammonium Bifluoride @ % <br /> ❑ HCI @ % <br /> Off-site Analysis (Certified): <br /> ❑ Anions ❑ DLIST ❑ Fish Toxicity ❑ Potassium only <br /> ❑ 608 ❑ DLISTTCLP ❑ Flash Point ❑ HEX Chrome <br /> ❑ 624 ❑ FLIST ❑ Percent H2O ❑ GAB <br /> ❑ 625 ❑ FLISTTCLP ❑ Explosives ❑ Tritium <br /> ❑ 8260 Total ❑ PCBs ❑ TATB ❑ Gamma Spec. <br /> ❑ TCLP 8260 ❑ Oil and Grease ❑ TTLC Metals ❑ TUPA <br /> ❑ 8270 Total ❑ TPH gas ❑ STLC Metals ❑ Curium <br /> ❑ TCLP 8270 ❑ TPH oil/diesel ❑ TCLP Metals ❑ Carbon-14 <br /> ❑ WVORG ❑ Total Cyanide ❑ Beryllium only ❑ Sr-90 or Tc-99 <br /> ❑ Other Analysis: <br /> On-site Analysis (Non-certified): <br /> ❑ pH/N ❑ Carbon-14 ❑ Hydrometer ❑ Paint Filter ❑ Flash Point <br /> ❑ Radscreen ❑ XRF ❑ Specific Gravity ❑ Solubility ❑ Boiling Point <br /> ❑ Rad Dee ❑ Peroxide Strip ❑ Liquefaction ❑ SCO Swipe& Survey <br /> ❑ Field Gamma ❑ Oxidizer Strip E Other Analysis: PARTICLE SIZE <br /> Date Sampled: 11/17/15 Time Sampled: 1000,1015,1030,1045,1100 <br /> Logbook Entry: DV-7; 30,31,32 COC#: 20219 <br /> Comments: <br /> Beta/Gamma(cpm)= Beta/Gamma BKG(cpm)= Alpha(cpm)= Alpha BGK(cpm)_ <br /> Container Activity(Ci)= Sample Activity(uCi)= Sample Volume(ml)= <br /> WGS 0009 Effective Date:8/12115 <br /> See WIC 111 Expiration Date:1/15/15 <br />