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EA., Waste Analysis Requ Form <br /> RUSH � G <br /> (� Approved by�taQ <br /> 9400818 WAA Start Date <br /> EAS Sample# Date Sampledq-12-2 <br /> HWM Requisition # Acct. # Date Submitted <br /> Building# 972 Room# RMMA ? Yes❑ No ❑ Date Completed <br /> #Bottles Submitted HWM Field Tech <br /> Send results to: L-Code 633 <br /> Comments: 6?c . 2y3 7 9 <br /> dc//-•7! y�.E�/-ACL_.. Tj.4T.d <br /> SAMPLE FROM(Record volume of liquid waste in tank when sampled.NOT maximum capacity of tank) <br /> ❑ Retention Tank liters, Tank# ❑ Tuff tank liters(1 gal.=3.8L) <br /> ❑ Carboy, :155 gal. Drum, 41 Other <br /> Process/Source generating the sample 22llc- /S-e7' <br /> SAMPLE DESCRIPTION (Check all that apply) �r <br /> Aqueous ❑ Coolant - (specify below) ❑ Soil <br /> mm <br /> ❑ Base - (specify below) -Z) Solvents - (specify below) ❑ Sludge, solid Co <br /> ❑ Acid - (specify below) :1Oil - • (specify, below) :1a <br /> Photochemicals � <br /> ❑ Other - (specify below) ❑ Silicon fluid ❑ UNKNOWN <br /> ❑ 2 liquid phases % (by volume; Top / Bottom (circle one) <br /> Composition(List all other components such wi hexane, laquer thinner, alcohol) <br /> ANALYSES REQUESTED (Discuss with Environmental Analyst assigned to the area) <br /> General Analyses Rad Analyses GC Analyses GC-MS Analyses <br /> pH/Normality ❑ Gross Alpha and Beta WHalogenated and ❑ Volatiles <br /> ❑ Anions ❑ Tritium* Aromatic Volatiles ❑ Semi-Volatiles <br /> ❑ ppm oil ❑ Gamma Spectroscopy ❑ Non-halogenated Vols TCLP Organics <br /> ❑ % oil */f only asking for alpha/beta or ❑ PCBs Cl Volatiles <br /> ❑ Cyanide 311,fill out a Limited NLTPHs ❑ Semi-Volatiles <br /> ❑ Flashpoint Radioisotope Certification form <br /> Metals Analvses <br /> ❑ TTLC Metals ❑ TTLC Ha <br /> ❑ STLC Metals ❑ STLC Ha <br /> ❑ TCLP Metals ❑ TCLP Hg <br /> TTLC/STLC Metals = Ag, As, Ba, Be, Cd, Co, Cr, Cu, Mn, A1o, Ni, Pb, Sb, Se, Tl, V, Zn <br /> TCLP Metals = Ag, As, Ba, Cd, Cr, Pb, Sc <br /> Other Analyses %�//- <br /> 1 cerrib- tlutt the above info mation is correct nd complete to the best of my knowledge <br /> Generator Signature �-- �� L- 633 Date <br /> Generator Name (prin Ext. ." pager) 4L-TZ"7 <br /> EAS Approval I �^— Date <br /> Rev 12. 22Scpt93 pmt ELAP Certification No. 1554 EAS (510) 424-4127 <br />