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r ( ( f C <br /> (® INTERNATIONALR/A C <br /> ( 001510 <br /> TECHNOLOGY REQUEST FOR ANALYSIS Control No. <br /> CORPORATION C/C Control No. 601510 <br /> PROJECT NAME n 6 fhu 4/6-zl DATE SAMPLES SHIPPED ///0?&/S: <br /> CJl�1 ✓ CR <br /> PROJECT NUMBER OL45 LAB DESTINATION a7 r,SaL`ki <br /> PROJECT MANAGER'�P p APA(/Dr LABORATORY CONTACT <br /> BILL TO T " ' ,n ' SEND LAB REPORT TO <br /> 'lar-1>n-e r-bti PZ <br /> PURCHASE ORDER NO. DATE REPORT REQUIRED /z - /5-.-q /. <br /> PROJECT CONTACT '-e i^ <br /> PROJECT CONTACT PHONE NO. <br /> Sample No. Sample Type Sample Volume ,Preservative Requested Testing Program Special Instructions <br /> Z -xeo owof /. <br /> "1111ilos or <br /> TURNAROUND TIME REQUIRED: (Rush must be approved by the Project Manager.) <br /> Normal Rush (Subject to rush surcharge) <br /> POSSIBLE HAZARD IDEJJTIFICATION: (Please indicate if sample(s)are hazardous materials and/or suspected to contain high levels of hazardous substances) <br /> Northward �/ 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 <br /> FOR LAB USE ONLY Received By / /�/ /��r�"�"'� " " ' <br /> Date/Time <br /> WHITE-Original,to accompany samples <br /> YELLOW-Field copy <br />