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® INTERNATIONAL q-1 I I O c D 178584 <br /> TECHNOLOGY REQUEST FOR ANALYSIS R/A Control No. <br /> CORPORATION C/C Control No. 2.40 tS" ; <br /> PROJECT NAME �1 1-- Smo o-�-,4-c s- DATE SAMPLES SHIPPED %k 1G1 q11( <br /> PROJECT NUMBER l4o`�+A7 -? LAB DESTINATION •.Cr1er1 --Tov_ <br /> PROJECT MANAGER SVoAPa q LABORATORY CONTACT <br /> BILL TO �& 45aS / hoc O,-7p,ii J SEND LAB REPORT TO <br /> it s fL , tvir7_ n �1455� 4585 ` ticb.eesu �t ►.�e� <br /> nn 4 � MTz COt �q55� <br /> PURCFIS0�EQ 41 1" DATE REPORT REQUIRED it 17 I9 <br /> �NvERM��IS1rLS PROJECT CONTACT n1. Mt1�5 <br /> • PROJECT CONTACT PHONE NO. C415� 3rlZ aY Ion <br /> Sample No. Sample Type Sample Volume Preservative Requested Testing Program Special Instructions <br /> r Jr <br /> OV, <br /> o�FR + cep-Il m�,-raL <br /> OVA TLC, <br />\o-7A <br /> TURNAROUND TIME REQUIRED: (Rush must be approved by the Project Manager.) <br /> Normal 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 <br /> FOR LAB USE ONLY Received By Date/Time _L2^ L ! �S <br /> WHITE-Original,to accompany samples <br /> YELLOW-Field copy <br />