Laserfiche WebLink
I F <br />9. Analysis Requested: Enter sample IDs and sample ID ranges separated by commas. For example, 1 3, 5 7, SampleIs) ID I <br />Samples) ID b. Organic Analysis <br />a. Inorganic Analysis L <br />--- - - <br />pH for Liquid (9040B) RH10 o-- - <br />Metals Scan (ICP -AES, 60106) RH10 — - <br />Cyanides for Wastes, Leachates(901013) <br />RH10 <br />WET (only if necessary) (ECL910-S) RH10 -- ----- -- - <br />other Metals: d. Other Analysis <br />c. TCLP Analysis <br />RH 10 --- - - - <br />Metals (only If necessary) <br />l <br />e. comments for Multiphasic Samples/Analysis Priority: pH Samples must be tested within 24 -hours <br />10. Analysis Objective: <br />Waste Characterization <br />11. Detection Limit Requirements: (Check ECL User's Manual to assure default DL is suffice.) <br />12. Supplemental Requests: Enter sample IDs as described in Item 9 E <br />13'. ECL Lab Remarks: <br />Desired Analysis ISample(s) ID Initials: <br />C <br />Da L <br />14. Chain of Custody: Signature Inclusive Dates of Custody <br />Name Title I j 11�� 7 to Yto Yr I <br />b. !c 7 to <br />c. <br />10 lldla <br />to a <br />co, toC <br />to <br />Department of Toxic Substances Control <br />Environmental Chemistry Laboratoni <br />State of California <br />California Environmental Protection Agency <br />Authorization Number <br />c� ^ 9 <br />ECL No.: -�_° o l:5- 2• Page <br />ENVIRONMENTAL CHEMISTRY LABORATORY 1. <br />To o 5 1 of 1 <br />SAMPLE ANALYSIS REQUEST <br />4. Program/Activity: <br />3. Requestor:(to Receive Results) a. Name: Alex Baillie <br />(street number) <br />HWM -SCD <br />b. Address: 8800 Cal Center Drive- <br />(city, state, �P) <br />5. TAT Level: __I -_ <br />— <br />Sacramento Ca 95826 <br />d• Fax: (916) <br />255-3595 (area code first) <br />'Unit Chiefs Signature: <br />c. Phone: (9 16) 2� 55-3751 (area code first) <br />�— <br />(if TAT level <br />e. Email: abaillie @dtsc.ca.gov <br />(mm/dd/yy) <br />( YY) <br />7. Codes (seleG tram drop down I sl or fill in .i apW,cablei <br />6. Sampling Information: a- Date/Time Sampled: 01/18/07 <br />- (#:## AM/PM) <br />a. Office HWM 01 --Sacramento <br />b. Location: EPA ID No. CAR000143776 <br />— <br />b. INDEX 6120 <br />Site: Lodi Chrome <br />(street number) <br />c. PCA ` 371 1 60 <br />Address: 316 North Main Street <br />(city state zap) <br />d. MPC 212 <br />Lodi CA 95240 <br />e. SITE WP -601057-33 <br />GPS-Lat: GPS -Long: <br />f. County 39--san Joaquin <br />GPS -Depth: <br />GPS -Alt: <br />�_ <br />f. Number of <br />8. Samples: <br />Container Size <br />containers g. Preservative / Field In <br />a.ID b. Collectors No. C. ECL No. d. Matrix <br />e. <br />/ L . <br />f <br />1 RH10 C C <br />_ <br />2 <br />- <br />3 <br />---- - <br />4 <br />- - <br />5 <br />6 <br />I F <br />9. Analysis Requested: Enter sample IDs and sample ID ranges separated by commas. For example, 1 3, 5 7, SampleIs) ID I <br />Samples) ID b. Organic Analysis <br />a. Inorganic Analysis L <br />--- - - <br />pH for Liquid (9040B) RH10 o-- - <br />Metals Scan (ICP -AES, 60106) RH10 — - <br />Cyanides for Wastes, Leachates(901013) <br />RH10 <br />WET (only if necessary) (ECL910-S) RH10 -- ----- -- - <br />other Metals: d. Other Analysis <br />c. TCLP Analysis <br />RH 10 --- - - - <br />Metals (only If necessary) <br />l <br />e. comments for Multiphasic Samples/Analysis Priority: pH Samples must be tested within 24 -hours <br />10. Analysis Objective: <br />Waste Characterization <br />11. Detection Limit Requirements: (Check ECL User's Manual to assure default DL is suffice.) <br />12. Supplemental Requests: Enter sample IDs as described in Item 9 E <br />13'. ECL Lab Remarks: <br />Desired Analysis ISample(s) ID Initials: <br />C <br />Da L <br />14. Chain of Custody: Signature Inclusive Dates of Custody <br />Name Title I j 11�� 7 to Yto Yr I <br />b. !c 7 to <br />c. <br />10 lldla <br />to a <br />co, toC <br />to <br />