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INTERNATIONAL <br /> TECHNOLOGY <br /> CORPORATION R£OUEST F0F1 ANALYSIS <br /> PROJECT NAME R!A Control No. 2"l-06 <br /> GIC Control No =' <br /> DATE SA <br /> PROJECT NUMBER l SAMPLES SHIPPED <br /> 1,.1�; z <br /> PROFIT CENTER NUMBER LAB DESTINATION :/L1 <br /> PROJECT MANAGER LABORATORY CONTACT iillly r % <br /> BILL TO -T �• ti.._ SEND LAB REPORT.To <br /> i <br /> PURCHASE ORDER NO. DATE REPORT RE=QUIRED <br /> PROJECT CONTACT j --`— <br /> PROJECT CONTACT PHONE NO. (Ls" Y <br /> Sample No. Sam ! T <br /> _� pe <br /> ype Sam <br /> ��_ "3 Sample Volume <br /> Preservative Requested Testing Program <br /> ` Cpeciai Instructions <br /> `7 q n9 t T <br /> r ro <br /> f � J <br /> S <br /> RCT <br /> / <br /> J ,. <br /> TURNAROUND TWE REOUIREp; (Rush <br /> must be approved by the Laboratory Project Manager.) QC LEVEL: <br /> w, <br /> Normal Rush (Levels II and 111 subject to surcharge;pro]ecbspecuic requirements must be + <br /> (Subject to rush surcharge.) submitted to lab before beginning work.) a <br /> POSSIBLE HAZARD IDENTIFICATION: l II <br /> (Please indicate it sample{s)are Sa2ardous materials andlor suspected to contain high levels cf hazardous subs.;races.) Project Specific 1 <br /> FI <br /> Moa-hazard r d <br /> Flammable 'Skin Irritant ! <br /> SA€NPLE QISPOSAL Highly Toxic f <br /> (Please indicate disposition of mole following and€ysis,Lab will charge for Packing.shi other <br /> f <br /> Return to Cllnnt ' � 9• .shipping.archive and disposal.] IPIe■■e Specify) <br /> Disposal by Lab t y <br /> FOR LA13 USE ONLY Archive (Ind!cate number of months.) <br /> Received by rr. <br /> WHITE•Or to accompany samples E• 0.1elT e:" 9 Tr! j !!t) 1f <br /> ELLC� ield „. ' <br /> _ .....- .. _... CC d <br /> a.. <br /> ..,._..,.. .. - - k.. .. .._ <br /> 77 61., <br /> :. - s_ _ •• } ._ � �.. .. 7 _ OBS h <br /> ;II <br />