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Stale of California <br /> Ag ns y Environmental Chemistry Laboratory Department of Toxic substances Control <br /> California EnvLonmental Protection e c o <br /> Sample Analysis Request Environmental Chemistry Laboratory tl <br /> 1.Req uestor Information: 2.Sampling Information: <br /> (To Receive Results): a.Date Sampled: 4119/2006 3.AuthorlZaNOn NO: )/ P 9 <br /> a. Name: Leo Valdez 4.Page: <br /> b.Site: 00 (EPAID <br /> ley F c <br /> b. Address: 700 He1nz Ave, c.Slfe: Blg Valley Ford � <br /> Berkeley CA94710 d.Address: 3282 Auto Center Circle S.Activity: Other 'n <br /> C. Phone; 510540-9875 Stockton CA <br /> as <br /> d. Fax: 510540-3875 - 6.TATLevel: 2 <br /> e.GPS-Alt: f.GPS-Depth: 'Unit Chief Signature: <br /> g.GPS-Lat: h.GPS-Long: c <br /> (if TAT level=l) zJ <br /> 7.Sam Is Information and anal sis re uested: c <br /> a ID b.Collector's No. aECL No. c.Matnx <br /> d.Container Type e.Contalner Size <br /> 9 0VF Ot (I«� O f.Field Information <br /> 2 BVF 02 O Other Sandpaper $60108 g.Daslred Analysts <br /> 3 aVF 03 Other Floor Drains $60108 i <br /> 4 C Other sanded off paint 560108 C L <br /> 5 <br /> 6 <br /> 7 H <br /> 8 <br /> 9 n <br /> n <br /> 10 b <br /> 11 <br /> 12 <br /> Comments(ifany) <br /> 8.Analysle Objective: 10-Codes: (fivaueppliceble) 11.Su lamantal Re oasts: <br /> Waste Characterization a.Offlce: 02 12.ECL L•3b Remarks: <br /> 9.Dectechon Llmlt Requirements: b,Index: 4040 D Desired Anal sis <br /> (Specify i/known and contact lab) C.PCA: 36211 <br /> d,MPC: H <br /> e.Sitel940366 48 M <br /> Initals: <br /> f.County: 39 Dafe; <br /> 13. Chain Of Custody: —�— <br /> a.I D <br /> _ b.Name c.Title d.si nature <br /> 1 c� e. Inclusive Dates of CUStod <br /> 2 / S /7 •C To / <br /> Gr LL e . <br /> S _ tan L <br /> 4 To <br /> To � <br /> 0 <br />