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State of California <br />palifti F i P 1 A <br />qzmW <br />Department of Toxic Substances Control <br />Mahe PaoNcopea fm Your Frle <br />Page 25 of 33 <br />ENVIRONMENTALCHEMISTRYLASORATORY I. Authorization Number ECL No.: B�pZ.t3(p$ ] Page <br />SAMPLE ANALYSIS REgUESIT <br />3. Requestor:0o Receive Reaelu) a. Name. Trevor Anderson <br />To Of <br />b. Address : 8800 Cel Cerner pave - - <br />- _ 4. Protect Name(If applicable): <br />_ <br />Sacremento, CA 95826 <br />I°I^u"^roan Stockton Propeller, Inc. <br />_ _ <br />0. Phone: (Still 845J634 p,ae maem°g tl. Fax: <br />lury.aha:pl <br />e. Email: _ trevocantlereon Qdhc.w.go,, <br />lenecseanmu STAT Level: 2 <br />B. Sampling Information: a. Dalerrime Sampled: 08/0321 <br />b. Location: EPA ID <br />(mmtddi BCotles pa.ur,,,,,arovmmwlw num. <br />No. WA <br />Site: Stockton Propeller. Inc. <br />smrrrabrs <br />f#:## AM/PM) a. Unit twuv.omuscnm„u uroene,wn,pAc1 <br />_ <br />Atltlrese: 2478 Wilcox Road <br />b. Project ID D�1SC915242g8 <br />_ <br />ferns nmbm c. Activity 10 36322 <br />Stockton, CA 95215 <br />her. a- avl J. MPC p1/A <br />GPS -let: GPS -tong: _ <br />GPS -AI[ - <br />e. County 391 Joaquin <br />a <br />GPS -Depth: <br />vs-S.p'a" <br />ECL f. Number of <br />a.to b. Collectors No. c. No. d. Matrix e. Container $¢e containers .Preservative/Field information <br />SP -10A %�010�k_ lM9 <br />2 <br />1 <br />3 <br />4. <br />6 <br />7 <br />8 <br />9 <br />9. Anal sis Re uested: Enter sample IDs antl sample ID ran es separated <br />b commas. For ezam a, 1-3,6-7,9 <br />a. Ino nic Anal sis Sam les ID <br />b. Or anic Anal IsF <br />Metals Scan (ICP -AES. 6010C) <br />Sam Is s ID <br />I <br />WET Metals (do WET regardless) f <br />EL <br />PH for Liquid (9040B or 9040C) <br />- <br />D <br />Other Metals: Chromium vi <br />- <br />o.TCLP Ana sis <br />d.Olher Ana is <br />Metals (do TC LP regardless) <br />_skar_aey'pkb2='FrahBrol <br />.:rill <br />sty <br />e. Comments for Multiphaat- Sam IaSIAna Sis Priority: <br />10. Analysis Objective: Waste Cleseifiwtian <br />11. Detection Limit Requirements: <br />12. Su lemental Re usata: Enter sample IDS as described In Item 9 <br />Desired Anal Is <br />13. ECL Lab Remarks: <br />Sam e a ID <br />E t <br />- Initials <br />� A <br />Dae <br />e <br />14. Chain of Cuelotl <br />Name Trite <br />a.Tae�1e All Sr.Ew• Sae-Avr <br />/nature Inclusive DatesofCustod <br />°. fY➢dcfue Ha+trjvaa Env. S<4e4.rd i 8116LI to WS/eft) <br />6 )I2+2! to <br />d. <br />to 0 <br />0 <br />t0 <br />b <br />070f4Q00 revo 1225/a017 ApprovedbvqueWV Maneoemanr nma. k <br />Mahe PaoNcopea fm Your Frle <br />Page 25 of 33 <br />