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05/09/2006 16:01 rAX 15105403891 DTSC SCD Q005/005 <br /> Cessrbrur4°r T�Ulb L Coc&6 SUPPLEMENTAL O <br /> hamrd. laboratoy - <br /> AUTHORIZATION REQUEST FORM (ARF) <br /> PART A : (Ey Requestor- PLEASE PRVM TAT Level <br /> (d�.cx one) •'1 2 3 Q <br /> Aequeslors Name L o '/,/Zr Z <br /> Region/UnitT F 7 S FAX - (.5-/O ) <br /> SACK-UP REQUESTOR . fIL¢-p �X� �- Phone ,so t 39S <br /> SITE: I V �� Fay +Lnm./Lc� <br /> PART S: Analytical Requests (By Requestor) (Lift � de(auft ,ct„e,5 <br /> muroberots—tleYt, Nunbe or 3w?xA rryp. <br /> Inorganic Analysis sold ua+d wtwi ce><r I Organic AnaJymis scrod uq j, cv.e <br /> Metals Scan (6010) CL-Pest(3C31) <br /> Metai(s)specific: OP-Pest(3141, <br /> WET g,, PCBs e032 <br /> off (2 R O F807:� <br /> C asides - D R d Motor Oil ML 8t 6) <br /> n-+iexm E#rarwabks 7684) <br /> cm.,.,-•+•w Flash Point (1C20 <br /> LTC_LfPAnaWJ3ysis •- vOC ,o.u , (3260) <br /> c V+..� e.. aP....— svccs (sz�a} <br /> Metals PAH9 70) <br /> Mer <br /> Vclaiz <br /> $emivolatiles <br /> Analysis Objective: OOnrwrp Hid standards Doddmow,d,) �` smsae• h.�`..-1��w.r:� <br /> (chec$(box) ®Wagle Ctma@rMIM =P.RGs =Cih� <br /> Detection LLmlt Requirementz: (na be stwnn W SAR aaa) <br /> (ap.r/,a care l+b a+pr.lue) <br /> Expected Date of Sample Arrival atLab --1--- - T-�- - T--1 <br /> PART C : (By STO - HML) - <br /> Authcruz on Number(ANI r J� g ARF's <br /> Name: Hazardous Materials Lab <br /> Lab to Receive Sample(s) <br /> — Address: 700 Heinz St., Ste. ISO —I <br /> �Berkeley, CA 94710 ❑ <br /> Sample Tracking Officer(STO) Check bvx 1f cancelled <br /> Today's Dete: <br /> ------t1---' -: Expiration Date - C 27J � ` 1 <br /> - - 6= <br /> TATL~: -1- 10-11 yr.( as pmt Wa-4g wWi) 2•:e-xl d•rr 3. r-Kyr+ I� <br /> Ili�is artllar n4ru 4�u.r aPPmMa1a lie"M',a/^^ a TTLC a.a.nn9 m V.s v-mip�st rtry Ia yrwera a re[➢"s a.edwl <br /> >4/6 h'!?r0.'I.Cl�M SrEt tti!�'1(C.^.PUI rrur Yy uv lo.....CL(a ae�rn.b.a[Ss tM aWa rtrdM/or CL cw^prspa) 1R7R <br /> I 'd ILZS-668 (0IS) OIddO Nd8E = 1 9002 ZT - JH <br />