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4e <br /> Y41 T£RHAVONAL A�c .' <br /> )�CiEI•IGii.CGY <br /> RIA Control No. 2 <br /> Y ' <br /> ED CU '1101 REGUFST'FOR ANALYSIS <br /> xA �C;p Cant aI No. � <br /> PROJECT NAME S Z`{�t DATE W.MPLES SHIPPED <br /> FRO.;EG"Y.IvLAAS1=R _ 7�3 LAB DESTINATION [tS <br /> PROFIT CENTER NUMBER 3 5 }{{ __ LABORATORY CONTACT Yk 0% <br /> �n ISL/ � - SEND LAB REPORT TO F� . LJ, <br /> PROJECT MANAGER — <br /> BILL TO <br /> DATE REPORT REQUIRED 2— Z,'}19 1 <br /> 'PURCHASE ORDER NQ. l ' ,n �1 f PROJECTCONTACT X41 <br /> PROJECT CONTACT PHONE NO. <br /> Sam43ie lta Sam;A&T Sample Volume Presorvative Requested Testing Program Special Instructions <br /> r 55— —2 ! _ 1 <br /> SS— ;�Vill <br /> 55 bce <br /> s s r - i TC d '�3+ FATE <br /> cise1 dor Till ' s. p W dn� <br /> c(31url CJ, n b,l06 1w, ja <br /> TUR TRush meet be approved by the Laboratory ill P isgec) M LEVE': (Lewis fl and$!I subjxt to surcharge,project-specific requirements must be <br /> submitted to lab Were beginning work.) <br /> (Subject to rush surehdrge.) 1_ II III Project Specific_ <br /> POSSIBLE HAZARD IDEN71FlCATION: (I indicate if samples}are hazardoc�e materials ardlor suspected to contain high levets of hazardou <br /> iaase a substances.) <br /> Eden iuessrdFlrrrema6le Skin h:..Int_� Highly Toxic Other <br /> 11i spsahl <br /> j <br /> SAMPLE DISPOSAL: (Please indicate disposition of sample foltooring analysis.Lab will chargo Rx packing,shipping.archive and disposal.) r <br /> Fleturn to Client! Disposal by Lab An:�Eve! -(Ir►dtcate numboi of month .) <br /> FOR LAB USE ONLY <br /> Recell Date/Time <br /> 12CA roe <br /> WHITE-Ori 'to ai::nmpww samples <br /> J <br />