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! State of California C .? ° `tcf I āœ“ Department of Toxic Substances Control <br />Fnvirnnmental Chemistry I abOfiltcry <br />ENVIRONMENTAL CHEMISTRY LABORATORY <br />SAMPLE ANALYSIS REQUEST <br />1. Authorization Number <br />ECL No.: <br />To <br />A c <br />? Z_ <br />2. Page <br />1 of 1 <br />I t0ECA15T <br />3. Requestor:(to Receive Resets) a. Name: Dylan Clark <br />b. Address: 8800 Cal Center Drive <br />Istreamneel <br />4. Project Name (if applicable): <br />_ <br />Sacramento, CA, 9 (mar, sur, e1N <br />5.TAT Level: 2 <br />c. Phone: (918) 255.4x09 (see coos ars) d. Fax: (gte)2sSO44s (,,,,xee%i <br />e. Emaildclark @dtsc.cs.gov <br />B. Sampling Information: a. Date/Time Sampled: <br />b. Location: EPA ID No. <br />Site: Oakland Bag <br />Address: 835 Aurora _ <br />Stockton, CA <br />GPS -Lal: GPS -Long: <br />GPS -Ah: GPS -Depth: <br />02/10(11 (mmlddlyy) <br />11AM-12 PM (s:ss AMIPM) <br />I.." rnenhn) <br />ra, sere, rip) <br />ā€”_ <br />7. Codes(sercl (foe, amp niwabehxePPIcAle) <br />a. Unit EaERP-OF" WCAWOrel lnwsbgo r <br />b. INDEX 4010 <br />c. PCA 38322 <br />d. MPC 404 OLA <br />e. SITE 914008.48 <br />if. County 39--san Joaquin <br />B,.Samply; <br />aID b. C 5acloes No. c. ECL No. d. Matrix <br />e. Container Size <br />I. Number of <br />containers <br />g. Preservative / Field Information <br />1 0081 JJn;!RJCJ Ink <br />4 oz clear glass jar <br />t <br />Kept on ice, pure ink product <br />2 0ahB2 T - ^ Mu ' <br />32 oz clear glass jar <br />i <br />Kept on ice, plate developer <br />3 0611 '? O9 <br />32 oz dear glass jar <br />1 <br />Kept on ice, used oil <br />4 ONt84 '7 ?-7 Mulliphosic <br />32 oz clear glass jar <br />1 <br />Kept on ice, water based Ink with ON <br />5 <br />8 <br />7 <br />8 <br />9 <br />9. Analysis Requested: Enter sample IDs and sample ID <br />cormnn. For example, 1-3, 5-7, 9 <br />y <br />a. Inorganic Analysis Sa <br />s) IOb. lc Analysis <br />S s) ID <br />I <br />Metals Screening by XRF (XRF) 2, 3, 4 <br />Flash Point 1020A) <br />1, 2, 4 <br />E <br />_ <br />L <br />D <br />F <br />Other Metals' <br />c. TCLP Analysis <br />d. Other Analysis <br />e. Comments ler Multiphasic Sam IesiAtud sis Priority: <br />10. Analysis Objective: Waste Classification <br />11. Detection Limit Requirements: (Check ECL User's Manual to assure default DL is sufficient.) <br />Need to test for waste classification. <br />12. Supplemental Requests: Enter sample IDs as described In Item 9 <br />Desired Analysis Samples) ID <br />Initials <br />Dale <br />13. ECL Lab Remarks; <br />L <br />a <br />Cvntq <br />L <br />SAes r1 tAoz'No -f AUD2'6Z <br />')--T 70 ATL -s <br />14. Chain of C <br />NWne Tdls <br />Signature <br />rrrGuaive, Dates of custody <br />a Dyllim Clark H.S.S./c <br />b. <br />a FJror c.. v -« l <br />tt to '2 h lā€¢ <br />to <br />S3 ro <br />c <br />a <br />d.0 <br />to _ <br />c <br />a. <br />I. <br />to <br />to <br />g, <br />j to <br />Ea02 (FEV 07110) Make Phdocoples rot Your Fire <br />/if. 6. <br />