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4 <br />State of California Department of Toxic Substances Control <br />California Environmental Protection Agency Environmental Chemistr/ Laborator/ <br />ECL02 (REV 9106) <br />Make Photocopies for Your File <br />ENVIRONMENTAL CHEMISTRY LABORATORY 1. Authorization Number <br />ECL No.: �{ �l �1D`1 2. Page <br />SAMPLE ANALYSIS REQUEST <br />&7S CC l 5�Q <br />To d 0i1 i1i . 1 of 1 <br />Requestor:(to Receive Results) a. Name: <br />Alex Baillie _ <br />4. Program/Activity: <br />'3. <br />b. Address: 8800 Cal Center Drive <br />4r V, r7,mber) <br />HWM -SCD <br />Sacramento Ca 95826 <br />(city, state. zip) <br />5. TAT Level: 1 <br />c. Phone: (9 16) 255-3751 (area code first) <br />d. Fax: (916) 255-3595 (area code first) <br />'Unit Chiefs Signature. <br />e. Email: abaillie <br />@dtsc.ca.gov <br />(if TAT level = 1) <br />6. Sampling Information: a. Date/Time Sampled: 01/18/07 (mm/dd/yy) <br />7. Codes (select from drop down list or fill in if applicable) <br />b. Location: EPA ID No. CAR000143776 <br />AM/PM) <br />a. Office HWlvl 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 <br />(city, state, zip) <br />d. MPC 212 <br />GPS-Lat: <br />GPS -Long: <br />e. SITE WP- 601057-33 <br />GPS -Alt: <br />GPS -Depth: <br />f. County 39--san Joaquin <br />8. Samples: <br />f. Number of <br />a.ID b. Collector's No. c. ECL No. <br />d. Matrix e. Container Size <br />containers g. Preservative / Field Information <br />1 I RH 1 IA' <br />iquid olid <br />2 IRH2 <br />Liquid, olid <br />3 I RH3 1' p9 <br />G q u ia ISo_lid <br />4 RH4 p0 9 <br />/qui Solid <br />f 6_4cL <br />5 RH5 0� <br />iqui /Solid I <br />6 I RH6 p <br />Liquid o f <br />7 RHT <br />i ui /Solid <br />8 R Hg <br />i ui /Solid I <br />t Ga%i <br />9 .RH9 Q r7 <br />Liquid/ oli _r- <br />/ tis-rfy% /u�� e <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 <br />Sample(s) ID <br />b. Organic Analysis Sample(s) ID <br />E <br />pH for Liquid (9040B) <br />jRH1, RH2, RH3, RH4, _ <br />- <br />1. <br />Metals Scan (ICP -AES, 6010B) RH1, RH2, RH3, RH4, . <br />Cyanides for Wastes, Leachates(90108) P1-11, RH2, RH3, RH6 <br />Cyanides for Wastes, Leachates(9010B) RH7,,RH9 <br />Metals Scan (ICP -AES, 60108) RH5,RH6,RH7,RH8,RH9 <br />pH for Liquid (90408) RH5,RH6,RH7,RH8,RH9 <br />WET (only if necessary) (ECL910-S) RH1 through RH9 <br />Other Metals: <br />c. TCLP Analysis <br />I <br />d. Other Analysis <br />Metals (only If necessary) <br />RHI through RH9 <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 13: ECL Lab Remarks: <br />u <br />Desired Analysis <br />Sample(s) ID Initials: E <br />C <br />{ <br />Date: <br />; <br />14. Chain of Custody: <br />Name Title <br />Si nature <br />Inclusive Oates of Custody <br />a. r' <br />(f % to <br />I/8(o <br />C. �Z / 1 Lv' i �'. is r T' <br />" �, .y <br />I : tixi�t <br />f /!,Z/L % to _ <br />t. <br />d. <br />to <br />ECL02 (REV 9106) <br />Make Photocopies for Your File <br />