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�fiiL2 <br /> I �9C i�t�FF i;I <br /> i INTERNATIONAL 207563 <br /> � -7 3 'f <br /> TECHNOLOGY E{EQUEST FOR ANALYSIS _� RIA Control No. Z O ! J5 6 <br /> CORPORATION 1_0 CIC Control No. - <br /> PROJECT NAME "rOCIC7oh3 DATE SAMPLES SHIPPED �I✓ z1y� Ei'� t ?1 <br /> PROJECT HUMBER 19QGj:17 - LAB DESTINATION —' f I�C C(. l r t <br /> _ -� <br /> PROFIT CENTER NUMBER _ SLI` LABORATORY CONTACT � <br /> PROJECT MANAGER SEND LAB REPORT TO -- I <br /> r r�+ri= <br /> _ BILL TO � _... --- � h--1 A rz'T i lJ a✓� a <br /> MA req I N_ <br /> DATE REPORT REQUIRED <br /> PURCHASE ORDER NO. y PROJECT CONTACT A ly w rVl�1E <br /> PROJECT CONTACT PHONE NO. �'It EM— <br /> Sample <br /> MSampte No. Sample Type Preservative Requested Testing Program Speclat Instwclions i <br /> YZ "r"Ge t-IItLai3 L—'1C)(•t11toZ.IlYrF,xpb.U• YtE's; -J ff i <br /> -rl'i •t:%l li rlr l rt l if; r r Litt� <br /> 1 �Y <br /> i-CX . T—II• LX-IIzNL'TAE'L6 <br /> - i <br /> TURNAROUND TIME REQUIRED. (Rush must be approved by the Laboratory ProjeM Manager.) OC LEVEL: (Levels 11 and III subject to so:!zharge;project•spocllic requirements most be � <br /> submitted to lab before beginning work,) <br /> Normal Rush (Subject to rush surcharge.) 1 �/ Il 111 Project Specific <br /> POSSIBLE HAZARD IDENTIFICATION: (Please Indicate if sampla(s)are hazardous materials and/or suspected to contain high levels of hazardous substanZeq.) <br /> Non-hsurd Ftemmablu__ Skln Jrrltanl Highly Toxic Other I <br /> (Pleese Specify) 1, <br /> SAMPLE DISPOSAL: (Please Indicate o!sposlllon of sampta following analysi&fab will charge for packing,shipping,archive and disposal.) <br /> Return to Client Disposal by Lab ✓ Archive (indicate number of months.) f <br /> 0R LAB USE ONLY <br /> • � <br /> Received by.- &ey- Date/Time � � � •,/� <br /> WHI <br /> rjr—al.to accompany samptes.TE-Oji f <br /> YELLOW- copy <br /> I <br /> j <br /> as <br /> r. i e <br />