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FA <br />S �I I lewe� c i Slj <br />Slate of California <br />I E IPr nAa n <br />..0 <br />Environmental eml <br />Deparlmof Toxic Substances Control <br />Chemistry L r <br />pa rm nvironmema <br />ENVIRONMENTAL CHEMISTRY LABORATORY 1. Authorization Number <br />ECL No.: AuoZ VK1 <br />2. Page <br />SAMPLE ANALYSIS REQUEST 46F99152 <br />To At4OZ9ZZ <br />i of 1 <br />7. Requestor:(to Receive Reeuim) a. Name. Dylan Clam <br />4. project Name (d applieablo): <br />D Address. 8800 Cal Center Drive tavw rWnaan <br />Sacramento, CA, 9 (oil, xaw m) <br />c Phone: (916)255-A909 caro cm. N.a d. Fax. (91s)2s54446 trsaaaa'+w <br />S.TAT Level: 2 <br />e. Email: oclarx @dtsc.na.gov <br />S. Sampling Information: a. Dete/Time Sartpled: 02/10/11 (moViAdtyy) <br />T. Codes tutu von Dere ao..nm«ra-. aaix o ) <br />b Location: EPA ID No. 11 AM -12 PM (1!M AM/PM) <br />a Unit FSERP.Olace or Cmw al "Naaaom <br />Site: Oakland Bag <br />It. INDEX 4010 <br />Address 635 Aurora taw aow; <br />c PCA 36322 <br />Stockton, CA Ir4r i w eol <br />d. MPC 404 OLA <br />GPS-Lat: GPS -Long: <br />e. SITE 914008.48 <br />GPS-AII: GPS -Depth: <br />1. County 39-san Joaquin <br />e. Samples: 1. Number of <br />a.ID b. Collector's No. c ECL No. d. Matrix e. Container Size containers g Preservative / Field Information <br />1 OakBI A RD Z&1 'I Ink 4 oz clear glass jar 1 Kept on ice, pure ink product <br />2 OakB2A0 Multiphasic 32 or dear glass jar 1 Kept on ice, plate developer <br />3 Oak83 � 9 K 0 7,e � Oil 32 oz clear glass jar 7 Kept on ice, used oil <br />�Z�p2 <br />4 OakB4 A DAO zZ ZZ MUlkphaslc 32 oz dear glass jar 1 Kept on Lc. water based ink with of <br />5 <br />6 <br />7 <br />0 <br />I g <br />9. Analysis Requested: Ems. sample IDs and sample IC ranges separated by commas. For example, 1.3. 5-7. 9 <br />y <br />Ia. Inorganic Analysis Samples) ID b. Organic Analysis Sample(s) ID <br />I <br />I( <br />I. <br />I/ <br />Other Metre <br />c. TCLP Analysis <br />d. Other Analysis <br />e. Comments for Multiphasic SampleslAnalysis Priority: <br />10. Analysis Objective: Waste Classification <br />11. Detection Limit Requirements: (Check ECL User's Manual to assure detaull DL is sufflciamt.) <br />Need to lest for waste classifieabon. <br />12. Supplemental Requests: Enter sample IDs as described in Item 9 <br />13. ECL Lab Remarks: <br />s <br />C-.--•�ts qu:�Zb� A- <br />Peaked Analysis Sample(s))D <br />J` <br />DRO(Diesel)&MotorOil (ECL816-M) 3 IabWs <br />( <br />Atoo282z SC..rr ti <br />A <br />FahBiceaxy (Title 22. FadiBio) 24 r. Oakf <br />s <br />14. Chain of Custody: <br />Name Title Inclusive Dates o/ Custody <br />o Sem 0c;4,(WI SAX to <br />�to <br />to <br />In <br />i <br />e to <br />I to <br />g to <br />ECL02 iRE v 071101 late Paote4aerla for you, fie <br />