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,A <br />State of California <br />Caldo rma Env ronmam.l Protec9On Aaemo, <br />Department of Toxic Substances Carnal <br />Outlay Mensgemenl OaYcer Make Pholocrplee for Your Fila <br />Page 24 of 33 <br />ENVIRONMENTAL CHEMISTRY LABORATORY <br />1. AuthorizatlOn Number <br />ECL No.: 6EbU(0p 2. Page <br />E(0 <br />SAMPLE ANALYSIS REQUEST <br />Toi of jee <br />3. Requaator.(to Receive Results) a. Name: Trevor Anderson <br />4. Project Name (If applicable): <br />b. Address: 8800 Cal Center Drive ;.w, exam„, <br />Stockton Propeller, Inc. <br />Sacramento, CA 95828 lcky. wu. eW, <br />C. Phone: (919) 6453834 pne wde firs, d. Fax: Iiine .me <br />6.TAT Leval: 2 <br />e. Emelt I erecuendil @dtsc.ca.gov <br />B. Sampling information: a. Datefime Sampled: 061OW21 (mmiti <br />7.Cod" p.aprfu, dWd. anarasm 6.ppiuA.l <br />b. Location: EPA love. NIA (p:ss AMIPM) <br />a. Unit xwMG.omo.mc„anmvmp..awte4q <br />Site: Stockton Propeller, Inc. <br />b. Project ID DI{8C91524248 <br />Address: 2478 Wilcox Road leve, naaw„ <br />C. Activity to 36322 <br />Stockton. CA 95215 Iwy. eu x e,) <br />d. MPC IVA <br />GPS-Lat: GPS -Long: <br />e. County 39—San Joaquin <br />GPS -Alt GPS -Depth: _ <br />8. Samples: I. Number of <br />&ID b. Collectives No. c. ECL No. d. Matrix e. Container Size containers g. Preservative f Field Information <br />( 01 SiC07A(a8 LAti 32ez 4 <br />- <br />z SP -02- {yet, ob I Wwe _ $241 (I e <br />3 SP -03 .13E CIl " Caa+r. _ 3zs S <br />4 Se-o4A se 01611 (jewep 3Rez { ze¢ <br />- <br />5 SP o5AeE0?'O Q. 6,11 32es- I �E <br />6 Gf-Olo SAY O"1.5 {d0e0 320s l RE <br />7 Se -W7 BS?01ilihil <br />9..SS'-eg. S3 Ozo .se <br />s e -o Bti10Sale zam ' <br />9. Analysis Requested: Enter sample IDs and sample ID ranges separated <br />by commas. For example, 14, 6.7 ,9 <br />y <br />a. Inorganic Analysis Sem les ID <br />b. Organic Analysis Sam les ID <br />I <br />Metals Scan (ICP -AES, 601 OC)6 <br />I- <br />WET Metals (do WET regardless) I — <br />p <br />_ <br />H for+ksw*(9040B or 9040C)(901 B) f—I <br />cw..lek,ee b 4 -5 <br />Other Metals: Chromium VI <br />c. TCLP Analysis <br />d. Other Analysis <br />Metals (do TCLP regardless) f—q <br />FefrBAessay({Me4FftiMtais} 4�+ (� {!.lpy <br />e. Comments for Multiphasic SamplestAnalysla Priority: <br />10. Ana"Is Objective: Waste Classification <br />11. Deviation Limit Requirements: <br />12,15Upplemental Requests: Enter sample We as described in Item 9 <br />13, ECL Lab Remarks: <br />Desired Analysis Sample( ID <br />o <br />8 <br />Initials <br />A <br />Date <br />a <br />14. Cheln of Custody: <br />Name Ties 1p S' afore Inclusive Oates of Cu <br />a F —)4,0R SR. &W. SIM~ 4/3lies{ to 3 SRI <br />b'(rt 0 me.4-44.. 6w. s[lavv}asf 4/ 3Jta11 ro <br />C. to <br />d. o <br />e. p <br />r. ro <br />o <br />Outlay Mensgemenl OaYcer Make Pholocrplee for Your Fila <br />Page 24 of 33 <br />