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er <br /> INTERNATIONALTECHNOLOG <br /> CORPORATIO2d REQUEST FOR ANALYSIS RIA Ccntrol No. `Z 3 U 011 <br /> i <br /> CIC Control No. 5c) <br /> PROJECT NAME �i�7 h DiT'_SAMPLES SHIPPED !" r! <br /> PROJECT NUR9BER a1 v C 3L ' <br /> LAB DESTINATIONnnq !X ; <br /> 3 � Ifrr FF <br /> PROFIT CENTER NUMBER LABORATORY CONTACT _ r f'�1'y✓ ?�f q 9 t <br /> PROJECT MANAGER f1� (1-!� Ylr•� SEND LAB REPORT TO <br /> BILLTO._ 1 - CX <br /> Pcr n� <br /> s <br /> DATE REPORT REQUIRED Z M 1 ' <br /> s PURCHASE ORDER NO. PROJECT CONTACT <br /> PROJECT CONTACT PHONE NO. �L <br /> Sample N,. . Sample Type Sampre Wtume Preservatira <br /> I: <br /> Requested , <br /> Roo Tesbn9 Parr+ S E <br /> Special Instructions646 <br /> .. <br /> - �—� <br /> 5 T- D <br /> U <br /> TURNAROUND TIME REQUIRED: (Rush must be approved by the Laboratory Project Manager.) OC LEVEL: (Levels Il and Ill subject to surcharge;project-speatie regv;ren►enss rmnt be <br /> � submitted to lab before beginning work) <br /> Normal ush _ (Subject to rush surzharge.) 1 11 tat p� <br /> spudrx <br /> POSSIBLE HAZARD IDENTIFICATION; (please indicate if sample(s)are hazardous mat9rials and/or suspected to contain high levels of hazardous sut seances,) <br /> a <br /> Non-hazard FlammableSkin Irritant HighlyToxic 00W <br /> �yh <br /> SAMPLE DISPOSAL:, (Please indicate disposition of sample following analysis.Lair will charge for (R—�� � <br /> i rg packing,stopping,archive and disposal.) <br /> Returnto Client Disposal by Labe_ Archive (Indicate number of months.) <br /> rr. <br /> FOR LAB USE ONLY, t <br /> t <br /> ReceNedhg # i t i.'x' + Date/Time s .0I <br /> samples <br /> {. <br /> WHITE-Orig... o alccampany sa ~ <br /> ,ELL eld CJ-- <br /> REPORT <br /> _ <br />