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I jr <br /> INTERNATIONAL <br /> TECHNOLOGY R/A Control No. <br /> - -- Immaufts CORPORATION REQUEST FOR ANALYSIS <br /> NAVE �' S+3Z_(4'y1 DATE SAMPLES SHIPPED 9 Z ���1t 01 No. r � <br /> PROJECT N� <br /> L�5 PROJECT NUMBER LAB DESTINATION —���1k Cis Ito — <br /> PROFIT CENTER NUMBER 5 Q LABORATORY CONTACT <br /> r 1' <br /> PROJECT MANAGER Y1"t_ SEND LAB REPOATTO <br /> H BILL TO <br /> t:�'5 3 <br /> DATE REPORT REQUIRED <br /> ?URCHASE ORDER NO. ir <br /> PROJECT CONTACT G L._.1 t\`t <br /> M PROJECT CONTACT PHONE Nt}, <br /> f� 3amole No.l, SampleTySample Volume Preservative Req 9 ram ueslad Testing Fr S <br /> f pecialInstructions , <br /> �,y S 5" �Z J • R <br /> s <br /> S5_ 1 5 1 t <br /> F}T� <br /> �— � ,¢ � <br /> Ti c,, <br /> Al Ans <br /> �o��r•n C� C, �„ b, cF P-6�w• 111 _ IJrT <br /> ;55 Pry z A. <br /> 5 <br /> TUR ' c� Rush must be approved by the Laboratory Project Manager.) OC LEVEL: (Levels II and Ill subject to Purchar f <br /> • l ge;pr 'ect-specific requirements mus!be <br /> W : <br /> �T �: ` submitted to lab before bi3gio.ning work.) <br /> Aio xtsf (Subject to rusR surchargc.) I,_ ` III Project Specific n <br /> ff <br /> POSSIBLE HAZARD IDENTIFICATION: (PleRse indicate it sample(s)are hazardous materials and Ior susp9ctad to contain high levels of hazardous substances.) <br /> Non hazard Flammable Skin Irritant Highly Toxic Other <br /> (Please specify) <br /> SAMPLE 0iSP0SAL: (Please indinle disposition of sample following analysis.Lab will charge for packing,shipping,archive and disposal.) <br /> Returnto.Cllent' Disposal by Lab Archive�[�_.___{Indicate numbe(F month .) ' <br /> FOR LAB USE ONLY f <br /> by Date/Time — 4 <br /> ReceivedZ/Za/5 i �y 3• Our 4 <br /> $ ELL teldi I r! <br /> WWE Orig. to ac_company,sampres . <br /> I d <br /> � r <br /> 1 <br /> • I <br />