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.. <br />Stale of California Department of Toxic Substances Control <br />Fnuirnnmenlal Chemistry Laboratory <br />ENVIRONMENTAL CHEMISTRY LABORATORY 1. AuthorizationNumber <br />SAMPLE ANALYSIS REQUEST IOEC0152 <br />ECL No.: _ 1t' 2, Page <br />To —.27— 1 of 1 <br />3. Requeator.(to Receive Resuns) a. Name: Dylan Clark 4. <br />b. Address: 8800 Cal Center D_rrve <br />Project Name (if applicable): <br />_Sacramento, CA, 9 _ lay. wr+. aP) <br />C. Phone: (918)255Afike Irs. mar 4s1 d. Fax: (916)25564"1. mn) <br />a Emait _ _ dclark Cdtsc.ca.gw <br />5.TAT Level: 2-- <br />-e <br />6. Sampling Information: a. Datelfime Sampled: 02/1(y11 (mm/dd/yy) <br />b. Location: EPA 10 No- 11AW12 PM (#1## AWPM) <br />Site: Oakland Bag _ <br />Address: 635 Aum_o (srw ruebr) <br />Slockton,_C_A (ay. si c sp) <br />GPS -Lal: _ GPS -long: <br />GPS -Ah: _ GPS -Depth: _ <br />7. Codas (ssba bm, cw kv n men ) <br />a. Unit EaEQc_omm o(G�mmal ImealiQeFa^i <br />b. INDEX 4010 <br />c. PCA 36322 <br />d: MPC 404 OLA <br />e. SITE 914008-48 <br />I. Count' 39-san Joaquin _ _ <br />8. Samples: f. Number of <br />a.ID b. Collectors No. a ECL No. d. Matrix e. Container Size containers 9. Preservative /Field Information <br />1 bakBl ✓ I Aun"jelInk 14 oz clear glass jar 1 lKept on sce, pure ink product <br />Oak82_' Musiphasic 32 ox Gear glass jar 1 Kept on ice, plate developer <br />_ _ <br />3 OekR3 �_ r2 Oil 132 oz dear glass jar 1 Kept on ice, used al <br />4 O2k54 ✓ Mukiphasic 32 m dear glass jar 1 Kept on ice, water based ink with oil <br />9. Analysis Requested: Entersample IDs and sample ID ranges separated by commas. For example, 1-3, 5-7, 9 <br />F <br />Ia. Inorganic Analysis Sarrwe(s) ID 1b. <br />Organic Analysis Sample(s) 10 <br />1 <br />Metals Screening by XRF (XRF) 2, 3, 4IllwilYiYYppBlerral.�.-_ <br />I1, 2, 4 4%, <br />E <br />Older <br />e. TCLP Analysis <br />d. Other Analysis <br />e. Comments for Multiphasic Samplet/Anaysis Priority: <br />10. Analysis Objective: waste Classilicalion <br />11. Detection Limit Requirements: [Check ECL Usees Manual to assure default DL is sufficient.) <br />Need to test for waste dassilicakon. <br />_ <br />12. Supplemental Requests: Entersample IDs as described in Item 9 <br />Desired Analysis ISample(s) IDI <br />Initials <br />13. ECL Lab Remarks: <br />A <br />e <br />E <br />C <br />L <br />— <br />Date <br />14. Chain of Custody: <br />Name ; Title Signature inclusive Dales of Cuslddy <br />a. Dylan Clark H.S.S. _ 9 /c Il ro Z rr �• <br />to <br />d. <br />- <br />t.—'------�------r------------ - to <br />9 i 1 to <br />