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Viazardous <br /> e Department of Health ices <br /> Materials Labor ry <br /> HML EXPRESS PLAN <br /> AUTHORIZATION REQUEST FORM (ARF) <br /> Part A (TO BE COMPLETED BY REQUESTOR) <br /> Requestor' s Name: AY! Priority Level <br /> S� <br /> TSCP Region / Unit: (PL) <br /> Phone Number: (9/6 ) �� ��� Z FAX: �SY —2 y <br /> Analytical Requests Planned: (circle analysis requested) <br /> # of # of # of <br /> Analysis Samps Type Analysis Samps Type Analysis Samps Type <br /> pH Vol.Org. Phenols <br /> HdSpce <br /> Metal 8010 Carbamates <br /> Scan 8020 <br /> 8240 T. C. L. P. * <br /> Metal Metals <br /> (specific) C1-Pest Volatiles ! _ <br /> Semivols. <br /> W. E.T. OP-Pest Pesticides <br /> ..Herbicides <br /> PAH Ext. Org. <br /> Screeng <br /> PCB 8080 8270 <br /> Expected Arrival Date of Samples at Lab: <br /> Analysis Objective Waste Charactzn. b. Treatment Stds. <br /> (circle one) c. Drink. H2O Stds. d. Other <br /> Detection Limit Requirements <br /> (if dif. than established DLs) <br /> Part B (TO BE COMPLETED BY STO) <br /> Authorization Number (AN) <br /> Expiration Date <br /> Lab to Receive Samples Name: <br /> Address: <br /> Sample Tracking Officer (STO) : <br /> Today' s Date: J � <br /> * Remember to list the analyses to be run on the TCLP extract on line 12 <br /> of the Sample Analysis Request (SAR) form. <br /> WY <br />