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NNE= MORE= <br /> i r N <br /> i <br /> 'r v <br /> P <br /> +q <br /> i <br /> _ I w <br /> INTERNATIONAL <br /> TECHNOLOGY RIA Control No. 2 7 6 0 0 9 !' <br /> CORPORATION REQUEST FOR ANALYSIS L �, � <br /> i <br /> ..�_. .__ C/C Control No. ��_ - _.-� <br /> PROJECT NAME :f';. Imo_ ,7cX tfin►`l _ DATE SAMPLES SHIPPED �L lei' L I)t if <br /> kk <br /> PROJECT NUMBER . 1�tl����_ LAB DESTINATION <br /> PROFIT CENTER NUMBER__ 2—:2; IZ LABORATORY CONTACT <br /> PROJECT MANAGER tt_L — SEND LAB kErvRT TO <br /> BILL TO lc <br /> r14r_T INE <br /> • <br /> /I 2T i NE Z G DATE REPORT REQUIRED . A - 01-9 I I <br /> PURCHASE ORDER NO. PROJECT CONTACT L LS � <br /> I <br /> �• PROJECT CONTACT PHONE NO. C Ir 72P tap <br /> Sample No, Sampfa Type Sample Volume Preservative Requested Testing Program Special Instructions <br /> L)-7 _�rL K (r.' IUE:L COOL -70 11"C <br /> 11,4JU7-S <br /> tt•, <br /> k .. <br /> 7Z'111✓rut-,� i '.'�' „d, '' U ��; a 1i. <br /> T <br /> J t <br /> 375`1tytjgq ?' r <br /> ue Cccri, 70 CC <br /> TURNAROUND TIME REQUIRED: (Rush must be approved by the Laboratory Project Manager.) W LEVEL, {Levets II and lll subject to surcharge;proloct•specifta roquiromccts must bo <br /> Normal submitted to lab before beginning work.) <br /> Rush (6ubject to rush surcharge.) 1 it 111 Project Specific _ s <br /> a <br /> POSSIBLE HAZARD IDENTIFICATION: (Please Indicate if sample(s)are hazardous materials and/or suspected to contain high levels of hazardous substances.) <br /> Non-hazard rrn .-�ti(,r Skin Irrltant�_ <br /> _ -. HI h! Taxfc PleawSpecify) <br /> •' ', <br /> i tr y Other f �� <br /> SAMPLE DISPOSAL: l I ` <br /> {Please indicate disposition of sample form,.;rx analysis.Lab wr7 charge for packing,shipping•archive and disposal.) <br /> . b <br /> Return to Client Disposal by Lab Arch�r.Q,t (Indicatrz number of months.) <br /> FOR LAB USE ONLY i <br /> ReceivedbY / Data/Time <br /> 7r <br />