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IN'f dRNATIONAI, I t < < 11 :0 9 <br /> TECHNOLOGY REQUEST FOR ANALYSIS R/A Control No. <br /> CORPORATTION C/C Control No. <br /> PROJECT NAME �'V A 7tlD/U DATE SAMPLES SHIPPED <br /> PROJECT NUMBER Lod(" 3 LAB DESTINATION SSC --P-L'/7 <br /> PROJECT MANAGER e4""14e'i fav?2 LABORATORY CONTACT <br /> BILL TO TEytk7ee 3J-11 SEND LAB REPORT TO �'e�r2 ��a2.9 QzjSl1>�rrg2< .r <br /> T �n <br /> PURCHASE ORDER NO. DATE REPORT REQUIRED jeci /J5i A?' <br /> PROJECT CONTACT �F'�`J'? L�u�P� n <br /> PROJECT CONTACT PHONE NO. o ��1.5 Z <br /> Sample No. Sample Type Sample Volume Preservative Requested Testing Program Special Instructions <br /> _3 t7 rx-9 Coo 7-Pb` 45 44r&4 AlAd a// GC 6K <br /> e, yo/ X 0I I PC' GII <br /> A P AJ /0 1114 hl ao Or <br /> Ar <br /> sad <br /> �qK/✓r0/'i 1 <br /> TURNAROUND TIME REQUIRED: (Rush must be approved by the Project Manager.) <br /> Normal 1/ Rush (Subject to rush surcharge) <br /> POSSIBLE HAZARD IDENTIFICATION: (Please indicate if sample(s)are hazardous materials and/or suspected to contain high levels of hazardous substances) <br /> Nonhazard Flammable Skin Irritant Highly Toxic Other <br /> (Please Specify) <br /> SAMPLE DISPOSAL: (Please indicate disposition of sample following analysis.Lab will charge for packing,shipping,and disposal.) <br /> Return to Client Disposal by Lab-4-4-- <br /> FOR <br /> ab-4-4'FOR LAB USE ONLY <br /> Received By /J� ���"�"`� � Date/Time / �f e", <br /> WHITE-Original,to accompany samples �--- <br /> YELLOW-Field copy <br />