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INTERNATIONAL �f <br /> m TECHNOLOGY R1AConIrolNo_ 276 <br /> REQUEST FOR ANALYSIS <br /> CORPORATION <br /> C!C Control No. <br /> PROJECT NAME . =1 ilraC'(-1 LA(Jc, DATE SAMPLES SHIPPED <br /> PHUJE(,l NUMBER ILAB DESTINATION _✓�e johJ A#oAu1T+Gi1_/ <br /> PROFIT CENTER NUMBER LABORAIURY CONTACT +1 AI"E CHOW <br /> 0 <br /> i PROJECT MANAGER S�VntCy jLc.✓ __—___ SEND LAB REPORT TO <br /> v BILL TO =,=J—L <br /> CA -- - - - —. UAI E RLPOHI HILOUIRED -- <br /> 1 PURCHASE ORDER NO. PROJECT CONTACT �� M ILLS, <br /> Sto 3 <br /> PROJECT CONTACT PHONE NO. <br /> w r <br /> H m Sample No Sample Type Sample Volvme Preservative Requested Testing Program Special bostructions <br /> z IIZ191 1 !F434L. 2"nr BttMSTtM GAOL• Y'C_ O ' G <br /> y <br /> o u <br /> H a cl4LATrr rJa'rE]=P -F0at cAVKC MwCow. 801-0 <br /> —— �3i'EX _ � 817za e2 6Ztit� <br /> - <br /> - - — F;tf!5 Ffi-F> r�A, ca jawo96 -- <br /> om <br /> oN — -- <br /> .-r u) <br /> .n + <br /> TURNAROUND TIME FIEOVIREO: {Rus must be appmced by Laboratory Prujecl Manager.) OC LEVEL QvvelU e;p <br /> and 111 etel to surchargtojacl-specijc requirementsmist be <br /> N suhmllled to lab before beginning work.) <br /> w <br /> Normal lild"A Rush (Subject to rash surcharge.) 1 II- III_ project Specific <br /> r9 POSSIBLE HAZARD IDENTIRCAT ION: (Please indicate it sampletsl are hazardous materials and/or suspected to contain high levels of hazardous submincos.) <br /> �.. <br /> Non-hazard � FlammableShin lrritanl _. FMghiy Toxic 01 hor_ <br /> �s jPleare Specify/ <br /> SAMPLE DISPOSAL: (Please indicate disposition of sample loilaving analysis.Labwill charge forpackinp•shipping,archive and disposal.) <br /> w Return to CgeM Dlspbse '�,^�rS• <br /> l 6y Lab.—! .— / r Archive {Indicate number of rsonths.) <br /> �\ <br /> FOR LAB USE ONLYsMJ,I I1+�I��I <br /> Received by __ Dale/Time_ <br /> y <br /> '-I <br /> • .'''vVHITE-Otiginal,to accoeipany samples <br /> -, YELLUN-Hold copy <br />