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9 <br />State of Califomia Department of Toxic Substances Control <br />California Environmental Protection A°encv Environmental Chemistr/ Laboratory <br />Inorganic Analysis <br />ENVIRONMENTAL CHEMISTRY LABORATORY <br />1. Authorization Number <br />ECL No.: C, <br />Page <br />RH10 <br />SAMPLE ANALYSIS REQUEST <br />TOo C S �j <br />L2- <br />of 1 <br />LGD /Sa <br />Other Metals: <br />3. Requestor:(to Receive Results) a. Name: Alex Baillie �; <br />4. Program/Activity: <br />d. Other Analysis <br />b. Address: 8800 Cal Center Drive v (street number) <br />HWM -SCD <br />5. TAT Level:— <br />Sacramento Ca 95826 (city, stale, zip) <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 level = l) <br />6. Sampling Information: a. Date/Time Sampled: 101/18/07 _ (mm/dd/yy) <br />7. Codes (select from drop down im or fill in if aooi rabie) <br />b. Location: EPA ID No. CAR000143776 I (#:##AM/PM) <br />a. Office HWM 01—Sacramento <br />Site: Lodi Chrome <br />b. INDEX 6120 <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 />S. Samples: f. Number of <br />a.ID b. Collectors No. c. ECL No. d. Matrix e. Container Size containers g. Preservative / Field Information <br />2 I _. <br />9 <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 OL is suffice.) <br />12. Supplemental Requests: Enter sample IDs as described in Item 9 <br />Desired Analysis ISample(s) ID -Initials: <br />Date: <br />14. Chain of Custody: <br />Name Title <br />a. <br />b. , ;l( yL <br />■ <br />T 13'. ECL Lab Remarks: <br />E <br />C <br />L a <br />Sionature dl Inclusive Dates of Custody <br />a /J <br />to ` <br />%Y7 �ti ! fid IO7 to <br />to <br />9. Analysis Requested: Enter sample IDs and sample ID ranges separated by commas. For example, 1-3. 5-7, 9 <br />Inorganic Analysis <br />Sample(s) ID b. Organic Analysis Samples) ID <br />IFa. <br />pH for Liquid (9040B) <br />RH10 <br />Metals Scan (ICP -AES, 60106) <br />RH10 <br />Cyanides for Wastes,. Leacfiates(90106) <br />IRH10 <br />WET (only if necessary) (ECL910-S) <br />RH10 <br />Other Metals: <br />c. TCLP Analysis <br />d. Other Analysis <br />Metals (only If necessary) <br />JRH10 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 OL is suffice.) <br />12. Supplemental Requests: Enter sample IDs as described in Item 9 <br />Desired Analysis ISample(s) ID -Initials: <br />Date: <br />14. Chain of Custody: <br />Name Title <br />a. <br />b. , ;l( yL <br />■ <br />T 13'. ECL Lab Remarks: <br />E <br />C <br />L a <br />Sionature dl Inclusive Dates of Custody <br />a /J <br />to ` <br />%Y7 �ti ! fid IO7 to <br />to <br />