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�,;. _, .'.,. 11 -_' -�• - <br /> 'FLS I i <br /> i3 <br /> .r., C. <br /> INTERNATIONAL <br /> TECHNOLOGY R/A Control No. 23 #3 0 8 F <br /> CORPORATION REQUEST FOR ANALYSIS <br /> /C Control No. <br /> PROJECT NAME `� 1 �' i ) DATE SAMPLES SHIPPED :� r <br /> PROJECT NUMBER ? 14 ('<<' LAB DESTINATIONS1":+r <br /> fi <br /> PROFIT CENTER NUMBER l` {" j LABORATORY CONTACT J 4•n; -';.f �_>,; „}i� 4 <br /> PROJECT MANAGER t i -' j SEND LAB REPORT TO <br /> BILL TO <br /> I i <br /> 1 t <br /> r DATE REPORT REQUIRED <br /> PURCHASE ORDER NO. PROJECT CONTACT ) �� �'-� ! r t <br /> PROJECT CONTACT PHONE NO. f l r,� 'r? A'� <br /> Sample No <br /> Sample Type Sample Volume Preservative RequesteciTesting Program Special Instructions ) <br /> ( b m t <br /> r <br /> TURNAROUND TIME REOUIRED: (Rush must be approved by the Laboratory Project Manager.) OC LEVEL: (Levels 11 and III subject to surcharge;project-specific requirements must be ' <br /> � ^. ,. submitted to lab before beginning work,) <br /> � <br /> Normal Rush (Subject o rush surcharge.) ! II !!I Project Specific <br /> POSSIBLE HAZARD rDENTIFICATION: (Please indicate it sample(s)are hazardous materials andlor suspected to contain high levels of hazardous substances.) v <br /> Nan-ha=ard Flammable Skin Irritant Highly Toxic Other <br /> (Meese Specify) <br /> SAMPLE DISPOSAL: (Please indicate disposition of sample following analysis.Lab will charge for packing,shipping,archive and disposal.) , <br /> F:c;urn to ClientDisposal by Lab Archive (Indlcate number of months,) <br /> FOR LAB USE O <br /> NLY ; <br /> Re <br /> calved - '`� DatelT(me <br /> ELL Leto'I <br /> r ' to accompany samples o as <br /> WHITE On � � <br /> 1 <br /> _.... _... ...... _. <br /> ,I <br /> IN <br /> Big <br /> { <br /> �A <br />