State of UlUUmla-r+ea~u~ eaU wel rare AgentY rep.rtm.nt ei !

f-~ HML No 1 3 gZPRIORITY l_1 T o(Explain)

HAZARDOUS MATERIALS SAMPLE ANALYSIS REQUEST

Col lecto r

LOCATION OF MPL)NGNam e

AddressNumber Street State Zi p

HML No. Collector's Type Of

(Lab Only) Sample No . Sample* FIELD INFORMATION-

lJ

A

Analysis Requested : Cr C

Title- Inclusive Dates

Special Remarks_

Signatur e

Signature

PART Ii : LABORATORY SECTION

Titl e

Titl e

Titl e

(e.g ., duplica te sample given to company, etc.)

Received By ]5 / "' _"_c4 Titl eSample Allocation : --- ❑ HML --- ❑ SCBL ❑ LBL ❑ Other

Analysis Required

inclusive Dates

Incl usive Oates

Date W., IT 2Dat e

'Indicate whether sample is sludge , soil, etc . ; Use back of page for additional information.;

I II I II i ii I 11111 111 1BNA03135434

Inclusive Dates

R

HDMSe00042213

All

7 f.2

e 7-R

II IBNA03135435

H DMSe00042214

SOUTP.r.'JN c;A3,1F0iRN A LABORATORY SECTIC?u

HAia.R.DDIIS MATERIALS MAIIAG=H TT tJNI T

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HDMSe00042215

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PhIUHI : ti

(Explain)

HAZARDOUS MATERIALS SAMPLE ANALYSIS REQUEST

Collecto rLOCATION OF 1PLI IIG :

Name

Address

T i m e s

-Tel. No. 7OV ` S '

NUnl tier Street State Zlp

HML No. Collector's Type OfcY 1 n IMMCnDhUATlnll • e

(Lab Onl y) Sample No Sample

lz~

Analysis Requested L /11//

✓1 /` i 1~ f~ 7

1, ~7Chain of C,Ijato~

ro . Title( Sl tgna u

St dsiA7ature

Signatur e

Special Remarks_

Signature

Tl ti e

Titl e

Tills

(e.g., duplicate sample given to conloify, etc .)

Inclusive Da)~

Inclusive Dates

Inclusive Dates

Inclusive Dates

PART IC LABORATORY SECTION

t_0 Title /7 ./w11 S/\ Date V1 0-1kRece ived By

1

-1 LBL 0 Other Date-Sample Allocation : ❑ HML ❑ SCBL E

Analysis Required

*Indicate whether sample is sludge, soil, etc. ; Use back of page for additional information .;

014S 0002 (5/80) Orig.-Lab. Dup.-Ilk Trip.-lnspoctor 1506-1.0 .ao ».

111 I II I II II I III I I I III II IBNA03135437

vii

HDMSe00042216

SOBTIILFN : LIFOR Ik LABORATORrSECTIO 1

LABO fiAT0RY REPOR T

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S IYffLING NO : ' ~-3 `f .

,iNA 1 '' ~_L PROCEDURES USED :

, /rte rf'z 7 - < '

AINALYS IS RESLLTO :

S C LN O : fG'

LA'I'E CF REPORT : 2

SJ~IkI I21G ~L.. :~' Z

!ATE R& E_ :: /~

e J,

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HDMSe0D042218

. OUTHERN CPI,IFORNIl LABGRATORI SECTIGIu

HAZARDOUS 1MTERMS MANAG 'ITT UNI T

LABO RA TOR r 3L?v ?

a 2v~d9~2

date

aa-~e

III III IIII II III I IBNA03135440

HDMSe00042219

Stang of Catttornla I-watt' « .e wNtwtAM °

P4iORitY(Explain)

~. - - 0queeileegl!d eMteptkllalelNl t

HML NoL-`--17

HAZARDOUS MATERIALS SAMPLE ANALYSIS REQUES T

C If Qate Sampl eaecor fLOCATION OF SAMP I T-

c t r }~ ~~ T.I. No .Name-~ -54 l L

~' 2t nAddress

HML No.(Lab Only )

Cullector' sSample No .

Number

(3R7 7 _G

i3 Y ?r2-s 0 rig3`f f

P ALP / ~ Ltftiir` 1,Stttrns

Type OfSample '

cI

Zie

FIELD INFORMATION''S~a~ l v _ h/a s f-e_

F"c. Cr.L ~K~ l°Cal

/V ✓ ~'„ .-~P f' 7

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/ 4 ~ ' 13

lO, sc~ 1J l You

Analysis Requosted :

fii l ~fi~G

t~~ti tl ~~

ChaltY Cus dY

to I nciut lve '. Dates

inclusive .DatesSIg u re

Signatur e

Special Remarks

Signature

Titl e

Titl e

(e.g., duplicate sa mple given to rornpany, etc .)

Inclusive Date s

Inclutlw Date s

PART II : LABORATORY SECTION

~r p I 1 / / p

Rece ived By Title `'b^ r y 17P aiti G l M•+ F Date Q *

Sample Allocation : ❑ HML SCBL ❑ LRL ❑ Other Date

Analysis Required

'Indicate whether sample is sludge, soil, etc. ; Use back of page for additional information. ;

OH50002 ( 3/00) Ong-Lab. Dup.-File Trip.-impactor tsoe7wsrm crwl r

1111111 1 I III II II I II II II III I I IBNA03135441

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ate

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HDMSe00042221

DATE C- -ERORT . _i%__ _

rtrc~.x.

BNA03135443

HDMSe00042222

TG c c c~ . SAMPLING ATE J '/ z

SAMPLE LOCATION :

r'1FL~ds NU : %'~74 j 219 DATE POEIVED :~, 7r~ _

C 6"- ~ GF?;- 'I IF,~XT 7-77 s 7 "- : ~ y~E - rZ-t oeE8 eP

C/D /=fP ~o/ a

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SAMP'I A n

NO . NLI GNO .

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