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I 'RNATIONAL t ! <br /> T--HNOLOGY. <br /> CORPOR.ATIOBT J <br /> REQUEST FOR ANALYSIS RIA Control No. 2 7 1�.9 � <br /> PROJECT NAME c. CIC Control No. <br /> =--'l�r eC ct l � �� r• r � <br /> PROJECT NUMBER — DATE SAMPLES SHIPPED <br /> I ��loi'►�l11 ��� <br /> LAB DESTINATION <br /> PROFIT CENTER NUMBER —� i ----�— <br /> _LL1 Kit a ' <br /> _ PROJECT MANAGERLLABORATORYTORY CONTACT <br /> t `Ti\tr s' i <br /> _ <br /> � <br /> BILL TO � . <br /> SENC LAB REPORT TO <br /> Z,�'7�� c'. � = •> --- -rpt "Iti t• � '# � <br /> A; <br /> �"'� I t•• RSE � �� c•c•,r,: _ f—I rtf:'i lnh: ..' Il 1'+� <br /> h� T REQUIRED <br /> PURCHASE ORDER NO. DATE REPORT <br /> PROJECT CONTACT <br /> i <br /> PRO' <br /> I ,rEGT <br /> . COMTA <br /> C <br /> T <br /> PHONE NO,Sample No. Sample Type .. <br /> '•it <br /> a <br /> f!t1 U <br /> Sample Volume i <br /> Preservative <br /> Requested Testing Program . <br /> 't 4,1f)7 t: x � �Cu1 •. - special Instructions <br /> ICl MI 1 `- <br /> 1..{ L T E <br /> to <br /> �v. <br /> t <br /> } .1 <br /> I MF <br /> TURNAROUND TIME R <br /> EQUTAED, (Rush must be approved by the Laboratory Project Manager.) QC LEVEL: L � <br /> a <br /> Normal_v' submit II and III before to surcharge;prulme-specific requirements must be <br /> Rush (Subject to rush surcharge.) submitted to lei before boglnnfng work.) <br /> ✓ 'f <br /> POSSIBLE HAZARD IDENTIFICATION: I�� II f1i 1 <br /> (Please indicate if sampie(s)are hazardous materials and/or suspected to contain high levels of hazardous substances.) Prelect Specific i <br /> Non-hazard ✓" <br /> Flammable Skin Irritant <br /> SAMPLE DISPOSAL: Highly Toxic Other w <br /> {Please Indicate disposition of sample following analysis-Lab will charge for packln shi In archive end dis <br /> Return to Client 9. <br /> hipping, possi.} °s7e Sv«Ih) <br /> Dlspooal by Lab -! f <br /> �-- Archive <br /> FOR LAB USE ONLY (indicate number of months.) ° <br /> Recelveci by l" <br /> WHITE-Ori G: I � DstelTime _ <br /> g a.to accompany samples <br /> YELLOW.Field copy � <br /> rzs�roes <br /> i <br /> t <br /> •: 1 <br />