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INTERNATIONAL.. <br /> TECHNOLOGY' ['� RIA Control No. 2 7 <br /> CO�PQRATION REQUEST FOR ANALYSIS <br /> C/ Cont CSI No. <br /> PROJECTNAM El' S `17J4\ DATE SAMPLES SHIPPED 2_/ <br /> PROJECT NUMBP,rR <br /> LAS DESTIMPON AsL <br /> • <br /> PROFIT CENTER NUMBER 3 S`{ t �gn <br /> I ' LABORATORY CONTACT n�, t� it <br /> PROJECT MANAGER <br /> SEND LAB REPORT TO <br /> BILL TO '�-T CiY p' <br /> y es N1.1,JA-0, ?=2,tV j <br /> C7g �4`�S3 Z Z_ <br /> � .,_ DATE REPORT REQUIRED �._-7'/°t <br /> 'URCHASE ORDER NO. PROJECT CONTACT I---J h"6t <br /> 7777� <br /> PROJECT CONTACT PHONE NO. 7110(3 <br /> Sample No. I Sample T Sample volume Preservative Requested Testing program Special lnslrue k= <br /> 4W C <br /> 55� -z I C <br /> SS' , -� s <br /> �- - Loi -b <br /> t <br /> 5s - t - 4 _ rr 1 dor <br /> ,r�1�rn Cd Ct 7-r bv cA P-6Olal ; I-IL7 ` ,A <br /> R <br /> �V. <br /> .' <br /> TUR Rush must be approved by the Laboratory Project Manager.] QC LEVEL: (Levels II and III subject to surcharge;project-specific requirements must be <br /> ""7 submitted to lab before beginning work.) ;q <br /> No at (Subject to rush surcharge-) I II lil Project Speci fe <br /> r <br /> POSSIBLE HAZARD IDEN`nRf;ATION: (Please indicate if sample(s)are hazardous materials and/or suspected to contain high levels of hazardous substances.) <br /> a <br /> Non-hazard Flammable _ Skin Irritant Highly Toxic Other <br /> Me—sp�hi <br /> SAMPLE CfSPOSAL. (Please indicate disposition of sample following analysis.Lab <br /> /will charge for packing,shipping,archive and disposal,) <br /> Retum to Client Qisposal try Lab Archive—( (indicate numbs=of month ) <br /> FOR LAB USE ONLY{ <br /> Received bN OatelTime <br /> ELL elo c accompany samples <br /> WHITE•Ong ;o a <br /> i E.-.-a. L__ t <br /> 1 <br /> Ir .gar <br />