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Slate of CaNOoua <br />California EnvnonrMnlal Plhl c n Agency <br />AUTHORIZATION REQUEST FORM (ARF) <br />Uepanmenl of Toxlt Substances Control <br />EnvlravrleMal Chemistry Laboa lay <br />SUPPLEMENTAL O <br />lona a svpde"an,x Requuedl <br />PART A: (By Requestor - PLEASE PRINT) <br />Turnaround Time (rAT): 'Rush ❑ "Level 1 ❑ <br />Requestors Name Dylan Clark _ <br />Region 01 -Sacramento <br />Back-up Requestor G8 WhAye <br />Site Name Oaklarld Bag <br />-Unit criers signature required: <br />2 0 3 ❑ (for Rush or TAT Level = 1) <br />Email dclark adlsc.oa.gw Phone( 916 ) 25549M _ <br />Unit FLERP-Orrice d Criminal Inveatipseens_ Fax( 916 ) 255-6446 <br />Phone( 916 ) 255-3607 <br />• s, rmF <br />PART B: Analytical Requests (By RequesiDr) (lab uses default methods fisted belay. Please specify as other requests.) <br />Inorganic Analysis <br />"j err of Samplasn a <br />Organic Analysis <br />Number of SamplesfType <br />SoedlLiquvawater• Other <br />Solid! LiquidlWater• Other <br />%Dry Solids (ECL730�- <br />IGRO (Gasoline, 80158) <br />Aridity (305-1) I <br />1 <br />DRO(Dissel) only (ECL816-M) <br />Alkerxtity (310-1) _ _ i <br />Moloy Oil only (ECL816-11A <br />Anions by IC (9056) ,' <br />: <br />DRO(Dlerl 8 MolorAt (ECL816-M)1�— <br />ChromiumVl(C'1by Colonmetrie(f195A) <br />i <br />Ell"renGlyool(ECL772-LI) <br />Chromium VI(Cf') in Water by IC (7199) <br />- <br />-� <br />PBDEc (ECL750.M) I <br />Cyanides for Wasles,Lepehates (9010-) <br />PCBs (8082) <br />Hardness (130-2) i <br />_11 <br />Pesticides- Chlorinated (8081 A) ! i <br />Merwryft) in Solids and Liquid (7473) <br />! <br />7F es - Organophosphate (el 41 A) ' it! <br />Merwry(Hg) in (Sempolid Wash (7471A) 1 I <br />1,4 -Dioxane (ECL830S) i <br />Mercury(Mg) in Liquid Waste (7470A) j <br />GCem51 Samivolatilas 182700) -- <br />metals SuaanngbyXRF TT <br />jVolalaea (82608) r <br />Metals Scan (60106. kr As.8a.Cu.Pb, arc) ! 3 <br />i <br />HPLC Carbonyl Compounds (8315A) ! -i <br />Metals Scan (for Drinking water. 6020A) <br />lExplosives (8330) 1 <br />Organolead in Waste (ECL938-AA) <br />IPAHs (831 D) 1 <br />Panicle S <br />10,Diotdnzlfonns <br />by HRGCIHRMS (ECLSMU i <br />Perchlorate for Soil,S ECL956-M) <br />FWh Point (I 020A) ! <br />Perchlorate for Water(314-0)Hexa <br />PH (90408, 90450) ! <br />TXO-Total Halogens in Og (ECL792-6) <br />Total Dissolved Solids (160.1) <br />; <br />(olrors. type k) IBTX on all <br />wEr(E-Cl.nas) O,M r.w..n Qoeanl re.. •, <br />- <br />wxra.lmsIn—---��-- <br />(Others. NPs in) <br />Iriolhors. qpe in) . <br />TCLP Ana 1saa <br />Other Analysis <br />Metals JOW., if.." pehrq.m." _ <br />- <br />Fish Bioassay Its 22) 2 <br />Merwry o"b. a"fe"r ❑ p."'°fa'm'e <br />Congener PCBs (ECL -CG -PCB) y <br />Voletiks o'll' x"'°"""'r oOk ,wffla. <br />I <br />Congener PBDEs (FCL•GG-PBD <br />6&rrlivdatlMs p"tr veee.mr pe Lr.fa.m.. ( <br />i <br />(drlers,rype in) <br />(Oft". type in) <br />(ethers, type in) I <br />Analysis Objective: Waste Classification <br />Spacial Instructions or Comments (For Example: Detection Limit, Sample Preparation, Extraction..,, etc.): <br />2 of (hese samples are flamnvnable inks, and one a developer. They are in their pure undiluted tarn. <br />Expected Sample Arrival Date: 02111 /11 (mm/dd/yy) <br />PART C : (By SMO . ECL) ARF•s Revision No. <br />Authoraation Number (AN) IDECO152-S Initials: Date: <br />Lab to Receive Sample(s) <br />ChfanLstry Lab ARF& Revision No. <br />_- Erniae^r^ initials: --__ <br />--ll��� 700 Hfmz Ave. suite 150 Date: <br />Sample Managemenl Officer (SMO) 7 W n / Berlin,".a W�m (510) 540-2189 <br />YAC��+ fes- ❑ Check box If cancelled <br />initials: Date: <br />Todayrs Date 03/17/11 (mmlddiyy) Expiration Date 64 0� (nm/ddiyy) <br />If Samples) Deeded to Contrxt Lab, Please Speciy <br />Reason ECL Personnel Confirmed: _ <br />ECL Contract Lap pager Not Ration or us or level =1): <br />Turnaround Time (TAT): - Rush fpr public health and Safety or emergency, 'Laval 1 = 1S days, 2. 30 days, 3 - 45 aye. <br />TCLP : If acne Fear r a aro afahple mauler type n apprope4m. lab may analyze or wean the samples) fast to derermins it TCLP is rweded. <br />RMareacr. ECL Users Manual. ECL01 (REV 08110t <br />