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INTERNATIONAL r r 2 7 6 0 5 5 <br /> TECHNOLOGY REQUEST FOR ANALYSIS RIA Control No. <br /> CORPORATION 1 - C/C Control No. -2f rl l <br /> PROJECT NAME STC` C,<TC�� DATE SAMPLES SHIPPED 11 l(10 <br /> PROJECT NUMBER LAB DESTINATION Meet -Thx <br /> PROFIT CENTER NUMBER + \ LABORATORY CONTACT <br /> PROJECT MANAGER Syc� y3Q_.0 M�\lS SEND LAB REPORT TO S. NAA ks <br /> BILL TO �15�5 �ctc c r,�t�l,lol 4SR_c:7 die her c� �I�a1 <br /> CA o 455 M-V7 , ea x4553 <br /> DATE REPORT REQUIRED l t (-1 let <br /> PURCHASE ORDER Na PROJECT CONTACT <br /> PROJECT CONTACT PHONE NO. C41S) -;�rl2-4tO0 <br /> Sample No. Sample Type Sample Volume Preservative Requested Testing Program Special Instructions <br /> 10A t —roiu\ It e-acL \Q01A Prev <br /> , 1A <br /> t t <br /> raA %t05 <br /> 3 AE r t <br /> 14A %kcNcTSp IL <br /> /SA <br /> A , <br /> /_M 1l S 1 <br /> TURNAROUND TIME REQUIRED: (Rush must be approved by the Laboratory Project Manager.) QC LEVEL: (Levels II and 111 subject to surcharge;project-specific requirements must be <br /> submitted to lab before beginning work.. <br /> Normal Rush )e' _ (Subject to rush surcharge.) I II III Project Specific <br /> POSSIBLE HAZARD IDENTIFICATION: (Please indicate if sample(s)are hazardous materials and/or suspected to contain high levels of hazardous substances.) <br /> Non-hazard X 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,archive and disposal.) <br /> Return to Client Disposal by Lab 3 Archive (Indicate number of months.) <br /> FOR LAB USE ONLY t, <br /> Received by Date/Time Lp IS— <br /> WHITE-Original,to accompany samples 126A-10.85 <br /> YELLOW-Field copy <br />