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- l <br /> 17-7 <br /> 1� <br /> INTERNATIONAL �` RIA Control No. 2 3 0 013 �� <br /> TECHNOLOGY REQUEST FOR ANALYSIS <br /> CORPORATION <br /> t Control No. <br /> PROJECT NAME "ii DATE SAMPLES SHIPPED <br /> LAB DESTINATION hq <br /> ' PROJECT NUMBER - . <br /> PROFIT CENTER NUMBER 3��j - LABORATORY CONTACT <br /> (/� R <br /> PROJECT MANAGER —TI)4A Wil MR—- SEND LAB REPORT TO <br /> BILL TO <br /> M 010-tIVlLB- CA DATE REPORT REQUIRED Z� i <br /> PURCHASE ORDER NO. q�� <br /> Z. PROJECT CONTACT <br /> PROJECT CONTACT PHCNE NO. �t . — <br /> Sample No. mple Type Sample Volume Preservative Requested Testing Program Special Instructions <br /> Jq• <br /> 55-t L-- u d I Soy�rtatt G.t C-C- t ' ` 1� <br /> 'a5T <br /> 't <br /> TURNAROUND TIME R ush must be approved by the Laboratory Project Manager.) OC LEVEL: (Lewis II and lit subject to surcharge;project <br /> requirements must be <br /> submitted to tab befora beginning work.) y- <br /> Normal flush (Subject to rush surcharge.) I <br /> It�� Ill Rx$tCt Spedtk <br /> p <br /> POSSIBLE HAZARD IDENTIFI N: (Please indicate if sample(s)are hazardous materials andlor suspected to contain high levels of hazardous substances.) . <br /> Non-hazard Flammable Skin Irritant <br /> HighlyTotrlc Other <br /> IPk—Specify) i <br /> SAMPLE DISPOSAL:! (Please indicate dis a following analysis.Lab wilt charge for packing,shipping,archive and disposal,) <br /> r _ � <br /> Return to Client Dispo by L9b Archive (indicate number of months} 2 <br /> s p <br /> FOR LAB USE ONLY' t <br /> ! Received by Date/Time <br /> I „WHITE-Ongoaccompanysamples - <br /> ELL aid I <br /> it <br /> ,l ' <br />