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Mel <br /> INTERNATIONAL R!A Con!ral Ni . 230013 <br /> TECHNOLOGY' REQUEST FOR ANALYSIS � �� <br /> CORPORATION 1C! Control No.�_ U T_...._-�� r <br /> �i f'(P'\ DATE SAMPLES SHIPPED �' — <br /> PROJECT NAME — K k4 " <br /> PROJECT NUMBER L.-.0 DESTINATirlI7 <br /> 3 LABORATORY GONTACT CL <br /> PROFIT CENTER NUMBER — <br /> W LA <br /> SA]LAB I�IrPORT'f0 <br /> EN <br /> PROJECT MANAGER ��. 0 <br /> BILL TO —_ <br /> 1 IV <br /> i IYI(.*si4 C;� DATE REPORT REOUIRED J- -- <br /> PURCHASE ORDER NO. z f �-9 PROJECT CONTACT <br /> PROJECT CONTACT PHONE NO. `=•-�-yam <br /> . ampleTypeSample Volume Pmserve!ive Requested Testing Program SPPc!al InstructionsaSdi SO) <br /> Tt;Stamplso? <br /> 6� <br /> T 1 <br /> _ ProManager.) OC LEVEL: (Levels II and III subject to surcharge•project-specific requirements must be <br /> I <br /> TURNAROUND TIME R ' ush mutt be approved t�y the Laboratory ) g ) <br /> I submitted to lab before beginning work.) )�s <br /> Project Specific <br /> Normal Rush (Subject to rush surcharge.) I 11 BE y <br /> POSSIBLE HAZARD IpENTIFI r N: (Please:ndicale if saniple(s)are hazardous materials and for suspected to contain high levels of hazardous substances.) , <br /> pI <br /> Nor.-hazard_. <br /> Flammable Skin Irritant Highly TOKIC Other {urease Specify) "I, <br /> e following an, <br /> is.Lai will charge tar packing,shipping,archive and diaposal.) <br /> SAMPLE DISPOSAL: (Please indicate die g € " <br /> Archive Inreatnumber ct months <br /> e nue ,) <br /> Return to Client Disco by Lab ld <br /> FOR LAB USE ONLYDatelTlme <br /> RecelveJ by <br /> r <br /> 177A 10 111. <br /> i accompany samples On ,i }d <br /> fr <br /> ELL ,. e!d c . w. <br /> . .... . � <br /> I K <br /> IJ 3 <br /> F <br />