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rr , <br /> ERNATIONAL T " CJ'kOL 3 f 0 <br /> TECHNOLOGY R/A'Control No. 178�2 S e <br /> CORPORATION REQUEST FOR ANALYSIS <br /> ' r , (er` CIC Control Na. <br /> PROJECT I'-IAME j DATE SAMPLES SHIPPED 9 9 f <br /> PROJECT NUMBER 0l /' <br /> LAB DESTINATION r�}5 St•. .Jzu <br /> PROJECT MANAGER Lt aA:. LABORATORY CONTfi:CT t <br /> BILL TO C0! t1+t•4 ah SEND LAB REPORT TO <br /> �15 NO <br /> PURCHASE ORDER NO. DATE REPORT REQUIRED E <br /> S Y 4 <br /> j '• rt <br /> PROJECT CONTACT <br /> PROJECT CONTACT PHONE NO. <br /> a , <br /> Sample No. Sample Type Sample Volume Preservative Requested Testing Program Specfal Instructions <br /> .z14 6:01lt <br /> IJ <br /> e <br /> M 1{ <br /> C ri" <br /> :< ai <br /> TURNAROUND TIME REOU[RED: (RLsh must be approved by the Project manager.) <br /> Lf) T <br /> Normal Rush_ (Subject to rush surcharge) M n C3 <br /> .. l.0a <br /> P05519LF:HAZARD IDENTIFICATION: (Please indicate it sampfe(s)are hazardous materials and/or suspected to contain high levels of hazardous substances) C <br /> Nonhaxard Flammable Shin Irritant Highly Tox1c Oihett/� D <br /> �!� - <br /> SAMPLE DISPOSAL: (Pli>ase indicate dispos'ion of samp!e following Analysis.Lab wii charge for paOIMV.shipping,and disposal.) I <br /> RerIum to ctiant _ Ofpposal by Lab...,,,. <br /> FR LAB USE ONLY <br /> Received 8y Date/Time <br /> j <br /> 'ITE-Original,to accompany samples r <br /> .LOW-Field copy <br /> • <br /> fit <br /> xS ys r�. <br />