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y. <br /> I <br /> I <br /> INTERNATIONAL 230011 <br /> TECHNOLOGY REQUEST FOR ANALYSIS R/A Control No. r r <br /> CORPORATION l C/C Control No. �J­702 _ <br /> PROJECT NAME �}�'` (7`TaTI Y� DATE SAMPLES SHIPPED = T <br /> ,1 <br /> PROJECT NUMBER r c)U 6 3L LAB DESTINATION r rhrlRr.Oi I x <br /> PROFIT CENTER NUMBER 3 j LABORATORY CONTACT _71, <br /> n lti f•ilr' r, YLf <br /> f:� �,ty y}r.L, SEND LAB REPORT TO <br /> PROJECT MANAGER ��. - <br /> BILL TO r 4 <br /> CJS " 4-553 DATE REPORT REQUIRED �2-111 <br /> PURCHASE ORDER NO. PROJECT CONTACT � - <br /> i �' rs' <br /> I PROJECT CONTACT PHONE NO. 7 ''1-wyw " <br /> Sample No. Sample Type Sample Volume Preservative Requested Testing Program Spacial Instructions 3 <br /> _ :J -2 - I <br /> A-1 <br /> 5 ♦1 — <br /> ) T . �A / ,a <br /> r 13 <br /> i <br /> TURNAROUND TIME REQUIRED: Rush must be approved by the laboratory Project Manager.) OC LEVEL: (Levels II and III aubjeet to surcharge;project-specific requirements must be r <br /> (' submilied to Itt)before beginning work.) <br /> Normal �~ Rush A (Subject to rush surcharge.) E 11 !II Project Specific <br /> POSSIBLE HAZARD IDENTIFICATION: (Please indicate if sample(&)zre hazardous malorials and for suspected to contain high levels of hazardous substances.) S <br /> ='I <br /> Nan-hl zard Flammable Skin Irritant Highly Toxic _ Other <br /> (Please Specify) <br /> SAMPLE DISPOSAL: (Please indicate disposition of sample following analysis.Lab will charge for packing,shipping,archive and disposal.) <br /> Return to client, Disposal by Lab -_ Archive (Indicate number of months.) �y <br /> i <br /> FOR CAB USE ONLY r <br /> Received by �w;. ` ,!r t ti. > _ Date/Time <br /> ^—^—__� .F <br /> _ <br /> WHITE-Origl, o accompany samples - - <br /> s. <br /> I <br />