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State of California <br />Califnrnia Fnvirnnmantal Prntar-tinn Anannv <br />Department of Toxic Substances Control <br />1-nvirnnmanfial I ahnrntnnr <br />ENVIRONMENTAL CHEMISTRY LABORATORY <br />1. Authorization Number <br />ECL No.: <br />2. Page <br />p <br />SAMPLE ANALYSIS REQUESTA"r0 <br />To <br />1 of 1 <br />3. Requestor:(to Receive Results) a. Name: Trev_ o_ rAnderson <br />4. Project Name (if applicable): <br />b. Address: 8800 Cal Center Drive <br />(street number) <br />Stockton Propeller, Inc. <br />Sacramento, CA 95826 <br />(city, state, zip) <br />c. Phone: (916) 845-3534 (area code First) d. Fax: <br />(area code first) <br />5.TAT Level: 2 <br />e. Email: trevor.anderson @dtsc.ca.gov <br />6. Sampling Information: a. Date/Time Sampled: <br />06/03/29 (mmlddlyy) <br />7. Codes (select from drop down list or fill in if applicable) <br />b. Location: EPA ID No. NIA <br />(#:## AMIPM) <br />a. Unit HWINIP-office of criminal Irvestigations(SAC} <br />Site: Stockton Propeiier, Inc. <br />b. Project ID DrC915242-48 <br />Address: 2478 Wilcox Road <br />(street number) <br />c. Activity ID 36322 <br />Stockton, CA 95215 <br />(city, state, zip) <br />d. MPC a<A <br />GPS-Lat: _ GPS -Lang: <br />e. County 39 --San Joaquin <br />GPS -Alt: GPS -Depth: <br />8. Samples: <br />f. Number of <br />a.ID b. Collector's No. c. ECL No. d. Matrix <br />e. Container Size containers g. Preservative 1 Feld Information <br />1 Se -00 <br />7f6 ill It SCP <br />2 5F-esg �- Ge''`'`° <br />- - - <br />libel. i <br />_ <br />s <br />- -- - <br />4 <br />6- <br />—� — <br />8 <br />9. Analysis Requested: Enter sample IDs and sample ID ranges separated by commas. For example, 1-3, 5-7, 9 <br />F <br />a. Inorganic Analysis Samples ID <br />b. Organic Analysis Salnpis(s} ID <br />I <br />u� <br />— - -- <br />L <br />L <br />WF=;� Metals (dg 4iii aft <br />D <br />Other Metals: Chromium VI <br />c. TCLP Analysis <br />d. Other Analysis <br />flpst <br />Fish Bioassay (Title 22, FishBio) <br />e. Comirri 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 />13. ECL Lab Remarks: <br />L <br />Desired Analysis S:ple,:s, ID <br />— — <br />Initials <br />C <br />L <br />A <br />Date <br />a <br />14. Chain of Custody: <br />Name Title <br />Signature Inclusive Dates of Custody <br />a7'1—*F- w% --S&-&%li - su <br />- 61; %2orti to 6131 <br />ra.�cr,rto 1L[o++r �u.,rrst <br />- - - to U� '11 <br />o <br />- <br />_ <br />e. <br />- <br />to <br />f. <br />to - - - <br />0. <br />to <br />07.0146.00_rev 012/2912017 Approved by Quality Management Officer Make Photocopies for Your File <br />Page 7 of 33 <br />