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State of Celik mis Calilomia Environmental Protection Agency AUTHORIZATION REQUEST FORM (ARF) Department of Toxic Substances Control Environmental Chemistry Laboratory SUPPLEMENTAL O (CMG a aupplenwal Rsgerud) PART A: (By Requestor - PLEASE PRINT) 'Unit chief's signature required.' Turnaround Time (TAT) *Rush [j 'Level1 ❑ 2Z 3 E (for Rush or TAT Level =1) Requeslors Name Dylan Clark Emal d_clark @dtsaca.gov Phone( 916 )2554909_ _ _ Region 01–Savamento 0111iE&ERP-0nimo(CrtmmNlnvestpatiom Fax( 916 )255-6416 Back-up Requestor Gil Whipple Phone( 916) 255-3807 xl r coog- Site Name Oakland Bag PART B: Analytical Requests (By Requestor) (lab uses default methods listed below. Please specify all other requests.) Number of Samples/Type Number of Samplss/Typ Solid Liquid Water Other Solid Liquid'Waler Other Inorganic Analysis 01 anic Analysis % Dry Solids (ECL730-S) — GRO (Gasoline, 801513) Acidity (305.1) DRO(Dieseo only (ECL816-M) Alkalinity (310-1 _ _ _ _ --DRO(Dieseq Motor Oil only (ECL816-M) Anions by IC (9056) 8 Motor Oil (ECL816-M) - — Chromium VI(Cfe') by ColorimeMc (7198A) EthylaneGlycol (ECL772-1st PBDEs (ECL750-M) _ Chromium \017 ) in Water by IC (7199) Cyanides for Wasles.Leachates (90108) PCBs (8!182) _ Hardness (1 3D-2) Pesticides - Chlorinated (8081A) __ _ Mer=ry(Hg) in Solids and Liquid (7473) Pesticides - Organophosphate (8141 A) Mer=ry(Hg) in (Semi),Sogd Waste (7471 A) 1,4 -Dioxane (ECL1330S) _ Mer=ry(Hil) in Liquid Waste (7470A) GCa4S:Semivolatikts (8270C) Metals Screening by XRF i Volatiles SMB) _ Metals Scan (60108, for As.ea,Cu.Pb, etc) HPLC,Carbonyl Compounds (8315A) Metals Scan (for Drinking water, 8020A) ,Explosives (8330)- PAHs (8310) OrgalloLead in Waste (ECL938-M) Particle Size (ECL740S) D'axins/Furans by HRGC/HRMS (EC80-M) Flash Point (1020A) Hexa TXO-Total Halogens in Oil (ECL792-S) (others, type in) 'BTX on all Perchlorate for Soil,Studge (ECL_955-M) _ Perchlorate for Water (314-0) pH (9040B, 9045C) Total Dissolved Solids (160-1) vveT(rCL910-S)U0xiyifneenavrY ❑ Doi_ audkx _ (others, type in) (other, type in) (others, type in) TCLP Analysis" Other Analysis Metals only ir...e...y ❑ oonoPmkss Fish Bioassay (Title 22) '2 Mer=ry ❑ °ny �r.«.,.,r> ❑ p.irnprdka Congener PCBs (ECL-CG-PC8) Congener PBDEs (ECL-CG-PBDE) (polefs."in) (others, type in) _ Volatiles drib lrnrc.w.> oo a..µrdkxi _ Sem;rwatilpb Onl>if ucnmrY pnerspkka (others, type m) Analysis Objective: Waste Classification Special Instructions or Comments (For Example. Detection Limit, Sample Preparation, Extraction..., etc.): 2 of these samples are 9ammmable inks, and one a developer. They are in their pure undiluted form. Expected Sample Arrival Date: 02/11/11 (mm/dd/yy) PART C : (By SMO - ECL) ARF's Revision No. Authorization Number (AN) 10AT0152 _5 Initials: Date: Lab to Receive Sample(s) Advanced Technology Labs ARF's Revision No. 3=, Walnut Avenue Initials: Date: Signal Hill, CAMMIMM %s Sample Management Officer (SMO) qtt: Diane Galvin (562)989-4045 (Jc/v" ❑ Check box if cancelled Initials:_ Date: Today's Date 03/17/11 (mmfddlyy) Expiration Date 04!01/11 (mMddlyy) If Sample(s) Directed to Contract Lab, Please Specify: Reason: ECL Personnel Confirmed: ECL Contract aD anger Wo-tti Ication (for Rush r–TAT-Level =1): Turnaround Time (TAT): - Rush for public heahh and safety or emergency, -Leval 1 = 15 days, 2 = 30 days, 3 = 45 days. 'TCLP'. It time permits and sample matrix type is appropriate, lob may analyre or screen the sample(s) first to determine if TCLP is needed Reference: ECL Users Manual. EC1.01 (REV MID)