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510 649 5271 <br /> JPN-22-1998 18 01 FP^m SAMPLE TRACKING OFFIC TO REG 1 SEB FPB P.01 <br /> I <br /> rkapartmant of Toxic Substances Cowl \AN 2 � i SUPPLEMENTAL <br /> Hazardous Matercals Laboratory (.b�Air rson <br /> vt.5.,,.etc 9S <br /> AUTHORIZATION REQUEST FORM (ARF) S 70 yS <br /> r <br /> PART A : (Sy Requestor - PLEASE PRINT) T•A -T S <br /> �O Requoelof'sName i' RegionlUnit1 � <br /> PherteNumber ( V) -3( FAX <br /> BACK-UP REWESTOR �TrC L Prone (S ) - <br /> SITE : <br /> Ara"cal Requests Plannfecl analysis requested) <br /> Arta"a s of SPIG S I T • is 0 of 1we I T • ' <br /> H s9 174 voi.Ort'. <br /> Metal Scan __. .lr1_ Hd& ce <br /> Metal a. Ct"t(v ff = smo <br /> W.E.T am <br /> PAH s tit <br /> PCBs 8080 T.C.LP s sdd/ <br /> cl-Pest Nettie <br /> OP-Pest valaillen <br /> C mates Semlivol. <br /> Extort'. Peetlotleg <br /> Sareen f <br /> S77 <br /> Expected oats of samples Arrival at Lab Z `d <br /> Analysts Ob)ective seta Characterization b. Troatmsnt Standards <br /> Circle One c. Qrittk M80 ep,Aarde d• OVWG : <br /> Detection Limit Requirements : <br /> PART B : ( BySTO - HML) <br /> Authorization Number (AN) II �I �I, 1LIL1�11�1�I <br /> Ekpirelon Date d Name: Hazardous Materials Lab <br /> Address: 700 Heinz St., Ste, 150 <br /> Lab to Receive 98mplea Name Berkeley, CA 94710 <br /> Sample Tracking Officer (STO) : <br /> Today's Dots : ��Q <br /> •sM typ <br /> TOTAL P.01 <br />