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State of California <br />California Environmental Protection Anpnev <br />Department of Toxic Substances Control <br />_rr"G...n or0nmer More vnotooepies Mr Your He <br />ENVIRONMENTAL CHEMISTRY LABORATORY <br />1. Authorization Number <br />ECL No.: <br />2. Page <br />Er_O <br />SAMPLE ANALYSIS REQUEST <br />To <br />1 of <br />1. Requestor.(to Receive Results) a. Name: Trevor Anderson <br />—_ <br />4. Project Name (if applicable): <br />b. Address: 8800 Cal Cellar Drive - _ —, <br />_ _ <br />- ivmeen <br />Stockton Propeller, Inc. <br />Sacramento, CA 95826 _ <br />_I:vax <br />IuN, sea ,pl <br />c. Phone: 19i6)8a5-3634(am csaefimn d. Fax: <br />tares toes nml <br />STAT Leval: <br />e. Email: _ h0vocanderson _@dmc.w.gov <br />_ _2 <br />- <br />6.Sampling Information: a. Date/Time Sampled: <br />06/0321 (mm/d&yy) <br />7. Cotlerpsig4 rmm amp'mmxx ar nil insaooi�®ael <br />b. Location: EPA ID No. N/A <br />_—_(#:##AM/PM)a. <br />Unit <br />HMP,00c. m C&au ema,uasa„Isnel <br />Site: Stockton Propeller, Inc. <br />_ - _ <br />b. Project ID <br />— — <br />DIf5C915242-08 <br />Address:2_478 Wilcox Roatl <br />Imaei m,mearl <br />C. Activity ID <br />36322 <br />Stoddon, CA 95275 <br />eum,:pl <br />d. MPC <br />_ <br />PITA <br />GPS-Lat: GPS -Long: <br />_lary, <br />e. County <br />39 -San Joaquin <br />GPS -Alt: _ GPS-Oepth: <br />_ <br />- - <br />8. Samples: <br />I. Number of <br />all) b. Collectors No. c. ECL No. d. Mahix <br />e. Container Size containers <br />. Preservative / Field Information <br />1 —O, _ ___..Latu re <br />32ez <br />— 2 SP -oz <br />--� <br />ail- -.z <br />1 <br />TLe <br />4,y <br />- – _– - _Aj_"% <br />.—$wiz—_. 1_ <br />SZLE <br />Low w-- <br />E <br />-6— --0-e---- ----- - ua9..a-__ <br />p <br />-SP 07 - — ---t <br />–-- <br />eP-_� <br />- l <br />9 SP_o 4 <br />32vt <br />/ <br />9. Analysis Requested: Enter sample Me and sample ID ranges saps <br />by commas. For example, 1-3, 5-7, 9 <br />f <br />a. Inorganic Analysis Sample(s) ID <br />b. OEganic Analysis <br />Sam les ID <br />I <br />Metals Scan (ICP -AES, 6010C) t _q <br />L <br />_— - <br />WET Metals (do WET regardless)_.Ltd <br />D <br />PH for Liquid (90408 <br />ONer Metalsn Chromium VI <br />c. TCLP Analysis <br />d. Other Analysis <br />Metals (do TCLP regardless) <br />eY+� <br />e. Comments for Multiphasic Samples/Analysis Priority: <br />10. Analysis Objective: Waste Classification <br />11. Detection Limit Requirements: <br />12. Supplemental Requests: Enter sample IQs as described in Item 9 <br />13. ECL Lab <br />Remarks: <br />Desired Analysis Sam les D <br />u <br />6 <br />Oats <br />s <br />14. Chain of Cust <br />Name Title <br />Signature <br />Inclusive Dates of Custotl <br />IF'lorvl.lew <br />a,—juJok.vklsW` FAV• Sata+lr - - <br />- _ <br />/3/2oz1 ro L ; et¢I <br />CS��M1• <br />bfrgWa,. f.AV, Stl avf'li)< _ <br />— _.. <br />i1 to <br />C. <br />.4�3/2sso <br />C <br />d. <br />to <br />e. <br />to <br />I <br />to <br />fo <br />_rr"G...n or0nmer More vnotooepies Mr Your He <br />