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4 <br />td <br />State of California <br />C-alifi-vnin Environmental Protection Agency <br />Department of Toxic Substances Control <br />Environmental Chemistry Laboratory <br />ECL02 (REV 9/06) Make Photocopies for Your File <br />ENVIRONMENTAL CHEMISTRY LABORATORY <br />SAMPLE ANALYSIS REQUEST <br />1. Authorization Number <br />ECL No.: o j 2. Page <br />To o v S 1 of 1 <br />/ L" G D /Sd <br />'3. <br />Requestor:(to Receive Results) a. Name: Alex Baillie ��. <br />b. Address: 8800 Cal Center Drive T (street number) <br />4. Program/Activity: <br />HWM -SCD <br />Sacramento Ca 95826 (city, state, zip) <br />5. TAT Level: _ 1 <br />'Unit Chiefs Signature: <br />(if TA /eve/ =. 1) <br />c. Phone: (916) 255-3751 (area code rirst) d. Fax: (916) 255-3595 (area code first) <br />e. Email: abaillie @dtsc.ca.gov <br />6. Sampling Information: a. Date/Time Sampled: j01/18/07 (mm/dd/yy) <br />b. Location: EPA -ID No. CAR000143776 (#:## AM/PM) <br />Site: Lodi Chrome _ <br />Address: 316 North Main Street (street number) <br />Lodi CA 95240 (city, state, zip) <br />GPS-Lat: GPS -Long: <br />GPS -Alt: GPS -Depth: <br />7. Codes (select from drop down iisl or fill in a applicable) <br />a. Office HWM 01 --Sacramento <br />b. INDEX 6120 <br />c. PCA 371_6.0_ <br />d. MPC 212 <br />e. SITE WP -601057-33 <br />f. County 39--san Joaquin <br />8. Samples: <br />a.ID b. Collector's No. c. ECL No. d. Matrix e. Container Size <br />f. Number of <br />containers g. Preservative / Field Information <br />1 RH 10 A -C Q G <br />2 <br />3 <br />4— <br />!� <br />5 <br />i <br />-.. -- <br />6 <br />7 <br />9I <br />_ t <br />9. Analysis Requested: Enter sample IDs and sample ID ranges separated by commas. For axample, 1-3. 5-7. 9 <br />a. Inorganic Analysis Sample(s) ID <br />111D <br />b. Organic Analysis SamplepH <br />for Liquid (9040B) RH10 <br />Metals Scan (ICP -AES, 60108) RH10 <br />Cyanides for Wastes,. Leacfiates(.9010B) RH10 <br />WET (only if necessary) (ECL910-S) RH10 <br />Other Metals: <br />c. TCLP Analysis <br />d- Other Analysis <br />Metals (only If necessary) RH10 <br />i <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 />Desired Analysis Samples) ID -Initials: <br />13'. <br />E <br />C <br />L <br />f <br />ECL Lab Remarks: <br />a <br />Date: <br />14. Chain of Custody: <br />Name Title Signature <br />F� <br />Inclusive Dates of Custody <br />'l t c / to <br />/ to <br />Fdc- <br />; <br />ECL02 (REV 9/06) Make Photocopies for Your File <br />