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State of California Department of Toxic Substances Coritroi <br />t' California Environmental Protection Acency Environmental Chemistry Laboratory <br />ENVIRONMENTAL CHEMISTRY LABORATORY 1. Authorization Number ECL No.: c�o� 2. Page <br />SAMPLE ANALYSIS REQUEST �% ��� SQ To - B 0 � . 1 of 1 <br />3. Requestor:(to Receive Results) a. Name: Alex Baillie _ 4. Program/Activity: <br />b. Address: 8800 Cal Center Drive V P /, ?/ rdetn tuber) HWM -SCD <br />Sacramento Ca 95826 _ (dry. state. Zip) 5. TAT Level: 1 <br />c. Phone: (916) 255-3751 (area code first) d. Fax: (916) 255-3595 (area code first) 'Unit Chiefs Signature: <br />e. Email: abaillie @dtsc.ca.gov Cf TAT level= 1) <br />6. Sampling Information: a. Date/Time Sampled: 01/18/07 (mm/ddlyy) 7. Codes (select from drop down list or tilt in if applicable) <br />b. Location: EPA ID No. CAR000143776 (#:##AM/PM) a. Office HWM 01 -Sacramento <br />Site: Lodi Chrome b. INDEX 6120 <br />Address: 316 North Main Street (street number) c. PCA 37160 - <br />Lodi CA 95240 (city, state. zip) d. MPC 212 <br />GPS-Lat GPS -Lang: e. SITE WP- 601057-33 <br />GPS -Alt GPS -Depth: 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 j RH1 iquid olid I ( _- <br />2 I RH2Liquid, Qlid <br />__—�- <br />3 I RH3 -' iqui Solid / !C64Z, C <br />4 RH4 p0iqui Solid <br />5 IRHS qui /Solid <br />6 I RH6 Liquid('90 l <br />7 RH7 1 iqui /Solid <br />8 RH8 •l j Mid /Solid_; <br />9 .RH9 0 0Liquid/ oli TU. <br />/ �s•r�s1 lu��t <br />9. Analysis Requested: Enter sample IDs and sample ID ranges separated by commas. For example, 1-3, 5-7, 9 F <br />a. Inorganic Analysis Sample(s) ID b. Organic Analysis Sample(s) ID I <br />E <br />pH for Liquid (90408) jRH1, RH2, RH3, RH4, <br />Metals Scan (ICP -AES, 60108) �RH1, RH2, RH3, RH4, <br />Cyanides for Wastes, Leachates(9010B) PJ -fl, RH2, RH3, RH6 _ <br />Cyanides for Wastes, Leachates(90108) RH7,.RH9 <br />Metals Scan (ICP -AES, 60108) RH5,RH6,RH7,RH8,RH9 _ <br />pH for Liquid (9040B) RH5,RH6,RH7,RH8,RH9 -_ <br />WET (only if necessary) (ECL910-S) RH1 through RH9 <br />Other Metals: <br />C. TCLP Analysis d. 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 t 13: ECL Lab Remarks: L <br />Desired Analysis Sample(s) 10 initials: E <br />C <br />r <br />Date: l <br />14. Chain of Custody: <br />Name j Title Si nature inclusive Dates of Custody) <br />I Ar fo -7 to <br />[b. to i ll?(c7 <br />U ca to <br />d. <br />�. to <br />