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,.n and•Wobm Agency <br /> OepwvnwKot.HwM Services <br /> Laboratory <br /> ,AZOIRDOUSMATERIALS 1. ion: H .g 5.!M5 2. <br /> -AMPtF--ANALYSIS" REQUEST _S 7— p •Z-[ T® <br /> s. R r ,a•/^- ?-t4d 4.Phone('Ac)4Cr _?L. L a . <br /> a. <br /> Address(To Pieceive Results): /4,10 e!✓ L.� <br /> 6.Date.Sampled 7. ime Sampled Hours 8.Codes(fig irrall applicable codes) <br /> 9.Activity: SEB C)SMB. O FPB ❑ATD ®PASO ®Other <br /> a.STC It t J <br /> b.Region 41) <br /> 1 ct SAMPUNG LOCATION, c.TPC <br /> / 1 a.EPA ID No. d. INDEX <br /> b.Site �1: C-`� a.PCA ` v <br /> T, ` f. SITE <br /> c.Address S `� � Sf g.County <br /> Nwww SINN city T+P <br /> 11.SAMPLES <br /> Sample Container <br /> a. ID b.Collector's No. c.Lab No. d.Type a.Type f. Size g.Feld Information <br /> C F <br /> I <br /> D E <br /> E L <br /> F D <br /> G <br /> H <br /> 12 ANALYSIS REQUESTED f. Q PCB k.Q Ext.Org <br /> �� (Screening) <br /> a. pH g.❑ VOA-H/S i.❑ F1ast <br /> Point <br /> b Metai 14 h.Q VOA-8240 m• Q <br /> Scan <br /> c.❑ Metals i. VOA-8260 n.❑ <br /> (Spec) <br /> d.❑ W.E.T. j.❑SVO-8270 0.❑ <br /> t3 SUPPE:EMENTAG::< Q ❑ Initials <br /> REQUESTS";: <br /> Q.. Date: <br /> 14.CHA OF CUSTOQY a�J <br /> a. w <br /> I Sim N r� D havo•eem Duo <br /> siol <br /> C. <br /> Sipes a N®rrme md.aw.win <br /> d. <br /> sem. <br /> N.®n-ms md� o... <br /> 15.SPECIAL REMARKS: <br /> 16.ASSIGNED TO: Date'>� 2 I <br /> 17.LAB REMARKS: L <br /> A <br /> B <br /> DHS 8002(Rev 10/90) Original-lab Duplicate-File Thpiicate-Inspector NLY(HML) <br />