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•k- kE q. <br /> I <br /> INTERNATIONAL RIA Control No. 230003 <br /> TECHNOLOGY REQUEST FOR ANALYSIS <br /> CORPORATION ! Control No.? - <br /> �l T L"VA DATE SAMPLES SHIPPED <br /> PROJECT NAME <br /> PROJECT NUMBER j 3 LAB DESTINATION --� nGr <br /> LABORATORY CONTACT �L'"�"F f�rC'It19� } <br /> PROFIT CENTER NUMBER <br /> PROJECT MANAGER lin L1 Y,h• SEND LAB REPORT TO <br /> BILL TO <br /> AA DATE REPORT REQUIRED 4: nn 3 a <br /> PROJECT CONTACT <br /> PURCHASE ORDER NO. ' `.c C <br /> PROJECT CONTACT PHONE NO. <br /> e Volume Preservative Requested Testing Program <br /> Special Instructions <br /> Sample No. Sample Type Sampl <br /> i <br /> P <br /> e,5 t- 0 <br /> i <br /> SSS Pt-1;S <br /> 3 <br /> 1 <br /> TURNAROUND TIME REQUIRED: (Rush must be approv©d by Ilia Laboratory Project Manager.) OC LEVEL: (Levels II and III subject to surcharge,project-specific requirements must be <br /> submitted to lab before beginning work.) <br /> I 1f IR Project Specific , <br /> Normal Rush t (Subject to rush surcharge.) <br /> I <br /> s materials and/or suspected to contain high levels of hazardous substances.) <br /> POSSIBLE HAZARD IDENTIFICATION: (Please indicata•it sample(s)are hazardou <br /> Highly Toxic Other ° <br /> Nen-hazard J' - Flammable Skin Irritant 9 y (Please Specify) t ` <br /> {� 3 <br /> SAMPLE DISPOSAL (Please indicate disposition of sample following analysis.Lab will charge for packing,shipping,archive and disposal.) <br /> Disposal b <br /> OIs - Archive (indicate number of months.) <br /> Return to ClIen: P Y tab <br /> FOR LAB USE ONLY <br /> Received by DatelTtme f rIt <br /> WHITE Crit.T td accompany samples.. . <br /> ELVJ eid 0 <br /> .f 'a <br /> I <br /> _ <br />