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s4 �ry <br /> i <br /> i <br /> ' <br /> INTERNATIONAL <br /> TECHNOLOGY11 <br /> CORPORATION 1 REQUEST FOR ANALYSIS <br /> 1 RIA Control No. 2 �i. <br /> l II <br /> , ~7. IC Control No. [ <br /> PROJECT NAMES 1 7`Z GATE SAMPLE SHIPPED <br /> ��� �~ ' <br /> PROJECT NUMBER !`:6/3C r:71_A STINAAON <br /> PROFIT CENTER NUMBER �I� � 1•ic � <br /> LABORATORY CONTACT !' <br /> PROJECT MANAGER _ r SEND L.,B REPORT TO ��- <br /> BlLLT0 <br /> t <br /> --1�� )'•r'- } DATE REPORT REQUIRED <br /> CJ � I <br /> PUP-CHASE ORDER NO. :� _ PROJECT CONTACT <br /> PROJECT CONTACT PHONE NO. ._�_ 3�iZ ! <br /> 8 r <br /> Sample No. Sample Type Sample Volume Preservative ` Requested Testing Program `Special Instructions <br /> I F, <br /> i– i �1 1.� 1 e. <br /> t '. i f.1�t„r <br /> r <br /> r ,111 <br /> i <br /> 5 5 P 5 <br /> - fps !s i .. <br /> 5 ,, <br /> �f S �w - 4 c 1� <br /> TURNAROUND TIME REOUIRED: (Rush must be approved by the Laboratory Project Manager.) Ow LEVEL: (Levels It and III subject to surcharge;broject-specific ruquiremenls must be <br /> Ix r'! submitted to lab before beginning work.) '( <br /> NormalRushr _i (ti(Sµtrject to rut stirfl(�f�p� I 11 III Project Specific t <br /> POSSIBLE HAZARD I NTIFICATION: (Please indicate it sampte(s)are hazardous materials and/or suspected to contain high levels of hazardous substances.) <br /> Non-hazard 1`_— Flammable skin Irritant Highly Toxic Ott-er <br /> . b <br /> (Plette sptctly) Ik as <br /> SAMPLE DISPOSAL: (Please indvate disposition of sample following analysis.Lab will charge to-packing,shipping,,rchive and disposal.) <br /> Retum to Client Disposalby L.sh 'l ! ATchive (Indicate number al months.) <br /> y�I ,• <br /> FOR LAB USE ONLY / L -- <br /> Received by •-- f!G”-( r'�� Date/Time 2 1r V <br /> ELL le # <br /> WHITE-Ony to accompany samples ! _ <br />