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0 <br /> INT ERNATIONAL. r :1 <br /> TECHNOLOGY RIA Control No. <3 0 <br /> CORPORATIO'_, REGUEST FOR ANALYSIS C 11 <br /> rol . j <br /> C!C Cont No. r -1a 2 I <br /> PROJECT NAME f�� `;(S� DATE SAMPLES SHIPPED <br /> PROJECT NUMBER I O!C)L"'3L LAB DESTINATIONri ttq l K _ <br /> t <br /> PROFIT CENTER NUMBER 3�+ LABORATORY CONTACT im I,4'/v H q y�, <br /> PROJECT MANAGER Afli �,fijrir•vvk:' Af <br /> _ SEND LAB REPORT TO <br /> BILL TO �X ; <br /> } � LI X9,5 ��r�r •,n� � <br /> �ar`j'�f1p�z 6-A X4553 DATE REPORT REQUIRED <br /> PURCHASE ORDER NO. PROJECT CONTACT L'✓ Ifs <br /> PROJECT CONTACT PHONE NO. 3:72-- °)1QQ i <br /> Sample Ido. Sample Type Sample Volume Preservative Requested Testing Program Special Instructions <br /> All <br /> 7S•� .r7-� � j __ <br /> � T-- 0— <br /> j <br /> V. AIN <br /> i <br /> rc <br /> i <br /> TURNAROUND.TIME AEQUIREO:_ , (Rush must Le approved by the Latvratory Project Manager.) OC LEVEL (Levels It and II[Subject to surcharge;pnqed speci[ic naquirsmerds must be <br /> — submitted to lab before beginning work.) <br /> Normal Hire—h r (Subiect to rush surcharge.) I If nl Project Specific <br /> POSSIBLE HAZARD IDENTIFICATION: (Please indicate it sample(s)are hazardous materials and for suspected to contain high levels of hazardous substances flu <br /> Non-hazard Flammable Skin Irritant_ Highly Toric Other ! <br /> (Reawr specify) <br /> SAMPLE DISPOSAL: (Please indicate disposition of sample following analysis.Lab will charge for packing,shipping,archive and disposal.) <br /> Return to Client i Disposal by lab Archive (indicate number of months.) <br /> FOR LAB USE ONLY <br /> Aecetvedby •n t 1x' , Dataffirne <br /> WHITE-Or!g oaccompanysamples tx.• <br /> ti <br /> ELI eldc1- 3ti r <br /> 1 <br /> S <br /> 1«_...; 1. ., [ _1 L.__I __� _.__E - ....i ! <br /> i <br /> i <br /> { <br /> i <br /> � r: <br />