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*%I <br />State of California <br />gency <br />Department of Toxic Substances Control <br />ENVIRONMENTAL CHEMISTRY LABORATORY <br />1. Authorization Number <br />ECL No.: VFliZO(P p 2. Page <br />�O <br />SAMPLE ANALYSIS REQUEST <br />To 1 of <br />3.Requestor.Oo Receivelxesuusl eName: Trevor Anderson <br />4. Project Name(if applicable): <br />b. Address: 8800 Cal Center Drive <br />tswel nvmbeo <br />Stockton Propeller, Inc. <br />Sacramento, CA 95826 <br />tub. max, np; <br />c. Phone: (916)945-363. lere.ranlcn d. Fax: <br />lana cod.rt r <br />S.TAT Level 2 <br />e. Email trewr.anderson @dtsc.ca.gov <br />6. Sampling Information: a. Datefiime Sampled: <br />06/030 (mm/dd/yy) <br />T. Cotler pees m.m.rooaP,n, 9et.rnlimv.ppr elet <br />b. Location: EPA ID No. N/A <br />(#:##AM/PM) <br />a. Unit ewxeomw aome.a mne9p.,m4sscl <br />Site: Stockton Propeller, Inc, <br />It. Project ID DIPC91524248 <br />Address: 2478 Wilcox Road <br />Pv.n n—., <br />c. Activily ID 36322 <br />Stockton, CA 95215 <br />(Gy. core. cont <br />d. MPC <br />GPS-Lat: GPS -Long: <br />e. County 39 --San Joaquin <br />GPS -Alt: GPS -Depth: <br />8. Samples; <br />f. Number of <br />a.ID b. Collectors No. c. ECL No. d. Matrix <br />e. Container Size containers . Preservative / Field Information <br />1 Ol B4 W(D'? L,p ,,, <br />32ez <br />2 SP -02 MUL01001 Ga.e <br />'3287- <br />3 $P�o3 P,@07-0" LI.n+r. <br />4 gP-044 gE 02J?I Vw141 <br />32.Di tICU <br />5 SP-o6A Bgoloa2 L1 w1• <br />32.. I �E <br />6 5P-06 94 01-0I$ 1.16wd, <br />32em l 1 C E <br />SP -o7 SIB Ca. -+y <br />�i d <br />aa4... I <br />6 sP-o 8 Beo20 <br />9 SP -0 looBn7.o <br />' <br />9. Anal Is Re uested: Enter sample IOs antl sample ID ran es separatetl by commas. For exam le, 13, 6-T, 9 <br />a. Inor anic Anal is Sam ie s) ID <br />b. Or anic Anal sir Sam les ID <br />F <br />I <br />Metals Scan(ICP-AES. 601 OC) (— <br />E <br />WET Metals (da WET regardless) <br />L <br />H for tkpib(90408 or 9040C 11045!) 1-4 <br />D <br />y-5 <br />Other Metals: Chromium VI <br />c.TCLPAnaI Is <br />d. Other Anal sis <br />Metals (do TCLP regardless) 1-9 <br />F-l� <br />C1n <br />a. Comments for Multiphaalo SamplaslAnalysis Priority: <br />10. Analysis Objective: Waste Classification <br />11. Detection Limit Requirements: <br />12. Su Iemental Re --eats: Enter ram le IDs as described <br />in Item 9 <br />13. ECL Lab Remarks: <br />Desired Anal sis Sam le(s ID <br />E <br />Initials <br />L <br />e <br />Date <br />a <br />14. Cham of Custody: <br />Name Title <br />a )�jREJoft .dCyiOr` r(f1l. Se"4wr <br />Signal. Inclusive Dates of Custod <br />4/3/20l to L; <br />C5�R. <br />rbn[ure M1sw FjW. St,1441rF <br />C, <br />( <br />�r-a---- 1.311011 to <br />d, <br />to <br />o <br />to <br />e_ <br />to <br />f. <br />m <br />motes rn rev0 12429R017 tlD <br />0 <br />_ Porn" yQuaLLy Managementolfcar Make Photocopies far Your File <br />Page 16 of 25 <br />