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*%i <br />State of California <br />Pal forms EnAronme=l Protect on Aaencv <br />Department of Toxic Substances Control <br />ENVIRONMENTAL CHEMISTRY LABORATORY <br />1. Authoriaadon Number <br />2. Page <br />ECL No.: 1B7Pmpeller, <br />(�O <br />SAMPLE ANALYSIS REQUEST <br />Togi of <br />3.Requestor.(bllecenie Results) a.Name: Trevor Anderson <br />4. Project Name (If: <br />b. Address: 8800 Cal Career Drivs _ <br />hv.., n,,,,,ee.l <br />Sto, Inc. <br />Sacramento, CA 95828 <br />;clsaeapt <br />c. Phone: (91084S3e3,1 cos nrep d. Fax: <br />p,u owe�elt <br />STAT Level:e. <br />Email trevecandereen @dtscOo.gov <br />Sampling Information: a. Daterrime Sampled: 08/03/21 (mm/dd/yy) <br />%. Codes(i000bcY ki.epglM,a) <br />b. Location'. EPA ID No. N/A <br />(#:## AM/PM) <br />a. Unit aw.nopelkruile c, <br />Site: Stockton Propeller, Inc. <br />It. Project ID DIPC915242.48 <br />Address: 2478 Wilcox Road <br />Pana mumtuo <br />c. Actbiry ID 38322 <br />Stockton, CA 95215 <br />Idly, ems. apt <br />d. MPC ii <br />GPS -Let: GPS -Long: <br />a. County 39 --Sen Joaquin <br />GPS -Alt: GPS.Depth: <br />8. Sample.: <br />f Number of <br />a.ID b. Collector's No. c. ECL No. d. Matrix e. Container Size containers g. Preservative /Field Information <br />10l Tba—MW <br />32ez <br />-I.a9Mle <br />2 5i02 WLSOl LA", <br />32m )� a, <br />3 SP -03 lie MCI" Lobi <br />3z,ie <br />� <br />4 Sill Be 02411 L+r.ro <br />32 -os. t M9 <br />5.Sr'c5.SEg-itia2_ Li1i <br />32-s- 1 �E <br />8 6P-010 _" 02M L"i <br />32ez l 3Z. E <br />Ste -D7. BB010a <br />- sr -09 <br />o - 8 eol . SpSpii <br />11 <br />9 <br />332,m ' ' <br />9. Analysis Requested: Enter sample IDs and sample ID ran es separated <br />by commas. For example, 1.3, 6T, 9 <br />y <br />a. Inorganic Analysis Sam les <br />ID <br />b. Organic Analysis Sem la a ID <br />I <br />Metals Scan QCP-AES, 811100)Qd <br />1 <br />8 <br />WET Metals (do WET regardless) (- 1 <br />D p <br />H for4rop"(904013 or 9040C)(10t0�_ <br />c►�.w1.. 6 <br />Other Nobel Chromium VI <br />c. TCLP Analysis <br />d. Other Analysis <br />Metals (do TCLP regardless) 1-9 <br />FiMB�aasaq�fislep9-FiNtpiej �(,� ((�yy <br />e. Comment for MuMphaslc BempleNAnalysis Pdodty: <br />10. Analysis Objective: Waste Classi9cation <br />11. Detection Limit Requirements: <br />12. Su (amental Re ue,mi Enter sample IDS as described in <br />Item 9 <br />13. ECL Lab Remarks: <br />Desired Analysis sample( ID <br />c <br />8 <br />Initials <br />L <br />4 <br />De a <br />s <br />19. Chain of Cuetatl <br />Nemo Title <br />S ature Inclusive Oates or Custod <br />5R. fjeJSarfwa.6T <br />a 1�1WEJINCa,4� <br />to /3 to g ta¢l <br />' <br />rraord lwn FiNf. ,rc2awfnv- <br />4/ 3/4011 ro <br />C. <br />,(�— <br />to <br />to <br />r <br />c <br />d. <br />to <br />c <br />e. <br />to <br />t <br />to <br />to <br />by Qaaay Mamagemeel Officer Make Pholocopies for Yom File <br />Page 11 of 20 <br />