Laserfiche WebLink
Stacl t.aQf' and WeNara " _ tof Services <br /> HAZARDOUSMATERIALS 1.Autha' ion:Number $.� 2 <br /> SA PMANAtLYSIS= REQUEST /� 3 Z. a .: <br /> .,. <br /> Requestor--.4/A- yid 4.Phone(Fa)Ll�' - U L L S. <br /> a.A .bjr:� ` <br /> Address(Ta Results): /pol'/ G,- Ga <br /> 6.Date.Sampled 7. ime Sampled Hours 8. Codes(fill in:all applicable codes) <br /> 9.Activity: &SEB O SMB. O FPB O ATD O PASD O Other <br /> a.STC if <br /> b.Region Q <br /> 1mSAMPLINGLOCATION. c.TPC <br /> a.EPA ID No. d. INDEX <br /> b.Site G,4 . cc? e.PCA 3 ` v <br /> f.SITE <br /> c.Address ""` C�G"� �f g. County <br /> N Sam City tip <br /> 11.SAMPLES <br /> Sampie Container <br /> a. ID b. Collector's No. c.Lab No. d.Type e.Type f.Size g. Field Information <br /> C F <br /> D <br /> E <br /> E L <br /> F D <br /> G <br /> H <br /> 12 ANALYSIS REQUESTED f. ❑PCB k.❑ Ext. Org <br /> (Screening) ' <br /> a. pH g.❑ VOA-H/S i.❑ Flash <br /> Point <br /> b Metal 14 h.❑ VOA-8240 m• ❑ <br /> Scan <br /> c.❑ Metals i.❑VOA-8260 n. ❑ <br /> (Spec) <br /> d.❑ W.E.T. j. ❑ SVO-8270 0.❑ <br /> 13:SUPPLEMENTAL: ❑ C3 Initials <br /> REQUESTS .- <br /> ® ❑ Date> <br /> 14. CH"of CusTo7-, --� o, — :%J`✓ �(/�J / / �✓ c��'- /j <br /> 2. ,pN �•.�ar. <br /> sem..b. 4a0VMx&1 , it �A',1 , ,�4 rf// .2 <br /> Sow— <br /> C. <br /> S; N®dt rb Inch.+.e nmm. <br /> d. / / - / / <br /> SNmwWrdlo lodwm Dow. <br /> 1S.SPECIAL REMARKS: <br /> 16.ASSIGNED TO: Date'�C <br /> 17.LAB REMARKS: L <br /> A <br /> B <br /> DHS 8002(Rev 10/90) Onginal-Lab Duplicate-File • Triplicate-Inspector NLY(HML) <br />