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State of California <br />Califnrniaa FnvirnnmPntal PrntPrfinn AnPnry <br />Department of Toxic Substances Control <br />Fnvirnnmantal r:hmmietry I ahrnratnnr <br />ENVIRONMENTAL CHEMISTRY LABORATORY <br />SAMPLE ANALYSIS REQUEST <br />1. Authorization Number <br />ECL No.: <br />To <br />L2.Page <br />of 1 <br />20AT0105-2 <br />3. Requestor.(to Receive Results) a. Name: Trevor Anderson <br />b. Address: 8800 Cal Center Drive (street number) <br />4. Project Name (if applicable): <br />Stockton Propeller, Inc. <br />Sacramento, CA 95826 (city, state, zip) <br />5.TAT Level: 2 <br />c. Phone: (916) 845-3634 (area code first) d. Fax: (area code first) <br />e. Email: trevor.anderson @dtsc.ca.gov <br />6. Sampling Information: a. DatefTime Sampled: 06/03/21 (mmlddlyy) <br />b. Location: EPA ID No. NIA (#:## AMIPM) <br />Site: Stockton Propeller, Inc. <br />Address: 2478 Wilcox Road (street number) <br />Stockton, CA 95215 (city, state, zip) <br />GPS-Lat: GPS -Long: <br />GPS -Alt: GPS -Depth: <br />7. Codes (select from drop down list or fill in if applicable) <br />a. Unit Hwimp-otnce of Criminal investlgations(SAC) <br />b. Project ID DTSC915242-48 <br />c. Activity 10 36322 <br />d. MPC NIA <br />e. County 39—San Joaquin <br />8. Samples: f. Number of <br />a.ID b. Collector's No. c. ECL No. d. Matrix e. Container Size containers g. Preservative / Field Information <br />I <br />SP -04A Liquid, Aqueous 32 oz clear glass jar 1 <br />Ice <br />2 <br />SP -05A liquid, Aqueous 32 oz clear glass jar 1 <br />Ice <br />3 <br />4 <br />5 <br />6 <br />7 <br />—d8 <br />9 <br />9. Analysis Requested: Enter sample IDs and sample ID ranges separated by commas. For example, 1-3, 5-7, 9 <br />p <br />a. Inorganic Analysis <br />Sample(s) ID b. Organic Analysis <br />Sample(s) ID <br />r <br />Chromium VI (EPA 7199) <br />1-2 <br />L <br />Other Metals: <br />c. TCLP Analysis <br />d. Other Analysis <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 IDs as described in Item 9 <br />Desired Analysis Sample(s) ID <br />Initials <br />13. ECL Lab Remarks: <br />C <br />L <br />L <br />A <br />e <br />Date <br />14. Chain of Custody: <br />Name Title _ Signature Inclusive Dates of Custody <br />a. Francisco Montalvan Environmental Scientist 6/3/2021 to .2- <br />2b. <br />b.fe to moi/ %'C722 <br />d. to <br />c <br />e. to <br />f. to <br />g. to Ppnp <br />07.0946.00 rev 0 9212912097 Approved by Quality Management Officer Make Photocopies for Your File <br />