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_ <br /> INTERNATIONAL r <br /> TECHNOLOGY R/A Control No. 276132 <br /> S <br /> '-ORPORATION REQUEST FOR ANALYSIS _ <br /> r a: CIC Control No. 2lr'- <br /> PROJECT NAME c .�- �aC KI0 K3 ; „ . � <br /> ' +DATE SAIuiPLES SHIPPED H ;`; ►��i �T' <br /> PROJECT NUMBEA r" I n I i r, �: : LA$DESTWATION: 1^c c,s;o., �trr y-h'ra.{ tl <br /> PROFIT CENTER NUMBgR. �; — - <br /> LA130RAMRY CONTACT"_ C pk,. <br /> PROJECT MANAGER' Vr-114z_ + r SEND IAB REPOIiTTO y� I� , <br /> BILL TO, <br /> F? i ►; e _ 11 44 .�_ ` _ - i c ', j, _ -T,—M rl <br /> � ;• .L�l G- • - ,7' ;'. s1 !' S �1' .-t°. j•G h_ - _ .F f 7 <br /> DATE REPORT NEQUfRED <br /> PURCHASE ORDER NO. <br /> �* PAOJECT C(dNTACT <br /> _ , T # PROJECT CONTACT PHONE N0: ] ioni" <br /> i- Sample Na. Sample Type c =Sample Volume Preservative I Requested Testing Program •' Spacial Instructions <br /> + <br /> O'r12: 1 P-1;W C-rMC)utr P -15 x L10 rrr }'IC - r <br /> 74 <br /> 17 <br /> e { C <br /> r <br /> TURNAROUND TIME REQUIRED: (Rush must be approved by the Laboratory Project M <br /> anagery,' OC LEVEL? (Lavols 11 and III subject to curchar�e;project-specific requirements must be <br /> submitted to lab before beginning work.) }' <br /> Normal Rush�r (Subject to rush surcharge) t ;I_� <br /> Ill f' Project Specific <br /> POSSIBLE HAZARD IDENTIFICATION: ' 'I <br /> '(Please Indicate If sample(s)are hazardous materials and/or suspected to contain high evels of hazardous aubstanea6.) + <br /> Non-hazerd� Flaminr6te s' :. ,.- t flrYr S r s r� <br /> Sklntrrtttntry_ r� HighlyToxle Other k <br /> SAMPLE p15P05AL i;, (Pfe9se Indlcste�l Itlnn of earn la following analysts.Lab will charge for ackinellf ]rim A a'� 23. <br /> + (Fleaa Spaclry) <br /> "!� P� !7r Pp i�r�rChive and diapoam}-.#r <br /> Raturlt io Cllerit Olaposal by Lel '., A ve I'i(Inds Ae nu'b*r of tiiorithay <br /> FOR LAB USE ONLY <br /> i ReceTiredby j. t h 'Rp=IelT►mai j i .r /''%t}fJ'•4.: rai+a <br /> I <br /> ri <br /> 1 <br /> h xt <br />