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State of California <br />Department of Toxic Substances Control <br />Environmental Chemistry Laboratory <br />ENVIRONMENTAL CHEMISTRY LABORATORY <br />1. Authorization Number <br />ECL No.: f�E� g v <br />2. Page <br />Q 4Z_ cc SQ <br />SAMPLE ANALYSIS REQUEST <br />To cn <br />1 of 1 <br />3. Requestor:(to Receive Resuits) a. Name: Alex Baillie <br />4. Program/Activity: <br />b. Address: 8800 Cal Center Drive (street number) <br />HWM -SCD <br />Sacramento Ca 95826 (city, state, zip) <br />5. TAT Level: 1 <br />C. Phone: (916) 255-3751 (area code first) d. Fax: (916) 255-3595 (area code first) <br />'Unit Chiefs Signature: <br />e. Email: abaillie @dtsc.ca.gov <br />(if TAT /e vel = 1) <br />6. Sampling Information: a. Date/Time Sampled:01/18!07 (mm/dd/yy) <br />�(#:##AM/PM). <br />7. Codes (select from drop down list or fill in if applicable) <br />b. Location: EPA ID No. CAR000143776 <br />a. Office HWM 01—Sacramento <br />Site: Lodi Chrome <br />b. INDEX 6_120 <br />Address: 316 North Main Street (street number) <br />c. PCA 37160 <br />Lodi CA 95240 (city, state, zip) <br />d. MPC 212 <br />GPS-Lat: GPS -Long: <br />e. SITE WP- 601057-33 <br />GPS -Alt: GPS -Depth: <br />f. County 39--san Joaquin <br />8. Samples: f. Number of <br />a.ID b. Collector's No. c. ECL No. d. Matrix e. Container Size containers g. Preservative / Field Information <br />1 RH1 00qn iquid olid <br />2 RH2 Az a 0 C3 ZI Liquid olid <br />3 IRH3 rGqui Solid <br />4 RH4OD9 /qui Solid <br />5 jRH5 iqui /Solid <br />6 RH6 1 p Liquid6ol <br />7 RH7 i ui /Solid I ,etr••� i'' `'� <br />8 RH8 0, o i ui /Solid <br />9 RH9 Q Liquid/ oli <br />9. Analysis Requested: Enter sample IDs and sample ID ranges separated by commas. For example, 1-3, 5-7: 9 <br />F <br />a. Inorganic Analysis I Sample(s) ID <br />b. Organic Analysis Sample(s) ID <br />I <br />E <br />pH for Liquid (90408) RH1, RH2, RH3, RH4, <br />_ <br />_ <br />Metals Scan (ICP -AES, 60108) RH1, RH2, RH3, RH4, <br />Cyanides for Wastes, Leachates(9010B) RH1, RH2, RH3, RH6 <br />Cyanides for Wastes, Leachates(90108) RH7,,RH9 <br />Metals Scan (ICP -AES, 6Q10B) RH5,RH6,RH7,RH8,RH9 <br />pH for Liquid (90408) RH5,RH6,RH7,RH8,RH9 <br />WET (only if necessary) (ECL910-S) RHI through RH9 <br />Other Metals: <br />c. TCLP Analysis <br />J. Other Analysis <br />Metals (only If necessary) RH1 through RH9 <br />e. Comments for Multiphasic Samples/Analysis Priority: pH samples must be tested within 24 -hours <br />10. Analysis Objective: 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 <br />13: ECL Lab Remarks: <br />L <br />Desired Analysis Sample(s) ID Initials: <br />E � i / f 1 � -7 <br />a <br />C J <br />l <br />Date: <br />14. Chain of Custody: <br />Name Title 1.4 Si nature Inclusive Dates of Custody <br />b..; L f5 1L�'? -- -.. ►Ii�fOZ to <br />u <br />C. Li vi i Ul li Z/r, 7 to <br />d. to <br />