Laserfiche WebLink
R <br /> INTERNATIONALTECH :9 <br /> CORPORATION <br /> RIA Control No. �J�J 14.4 <br /> CORPORATION RS�UEST FOR ANALYSIS <br /> PROJECT NAME CIC Control No. <br /> y DATE SAMPLES SHIPPED 2 <br /> PROJECT NUMBrN <br /> ER LAB DESTINAFION +^ <br /> PROFIT CENTER NUMBER �- LABORATORY CONTACT' �b� ,�r a 1 �• t <br /> PROJECT MANAGER Dr'r i V� ,�1ti0 s <br /> SEND LAB REPORT TO <br /> BILLTO <br /> i <br /> vr . -----_ _ ' . <br /> I:"J:.�ti rA 115 S 1 DATE REPORT REQUIRED <br /> _ PURCHASE ORDE=R Na PRO IECT CONTACT r <br /> PROJECT CONTACT PHONE NO. <br /> Sample No. ! Sample <br /> r r TSample Vol,u.me Preservative Requested TestingyProgram <br /> Special Instructions , <br /> IT" <br /> a <br /> t-t <br /> TUAU;ROUND TIME r.EOUIRED: (Rush must be approved by the Laboratory Project Manager.) OC LEVEL: r <br /> (Levels II and III subject to surcharge;pto)ect•specific requirements must be <br /> Normal --Rush 1 submitted to lab before beginning work.) <br /> a (Subject to rush surcharge.) I II Itt Project Specific <br /> POSSIBLE HAZARD IDENTIFICATION:. (Please indicate if sarnple(s)are hazardous materials and for suspected to contain high levels of hazardous substances.) <br /> Nan•hatard�: r'�tatnmable_ _ Skin Iffitant <br /> Highly Toxic Other <br /> SAMPLE DISPOSAL': (Please Indicate dispcaltiorToi m le followin anal (please specny) <br /> jck P 9 analysis.Lab will charge for packing,shipping,archive and disposal.) <br /> tletum to Client;...; Disposal by Lab Archfve_ (Indicate number of months.) <br /> FOR LAB USE ONLY - - <br /> j r <br /> Received by DatelTlme fi I- <br /> WHITE-Orn( to accompany samples <br /> { .,ELL -'erd 9 ; 1 I _ <br /> b <br />