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� r r r r r � r r r r r rri ar r�i ■rl r r �r <br /> INTERNATIONAL 276144 <br /> TECHNOLOGY R/A Control No. <br /> CORPORATION REQUEST FOR ANALYSIS <br /> C/C Control No. Z�ot-14 <br /> PROJECT NAME � P M 11rZC.N LAI`QE a DATE SAMPLES SHIPPED 4'IeTei-_,`J 1 I -Z I -9 ( <br /> PROJECT NUMBER y I4aB9Z - - LAB DESTINATION zEL6tOAJAti34-u1/TrC.aAt� <br /> PROFIT CENTER NUMBERS y. LABORATORY CONTACT- <br /> PROJECT <br /> ONTACTPROJECT MANAGER 5yr;N Iry SEND LAB REPORT TO ZT cow <br /> BILL TO "T�i— C��- �I T- CH ECO 1� <br /> I. S N E-CJ7 -40[_Vn. _- <br /> M frz171104 CA DATE REPORT REQUIRED I J - Zz-41 <br /> PURCHASE ORDER NO. PROJECT CONTACT !EDlr h F-V I U c- <br /> PROJECT CONTACT PHONE NO. IOO <br /> t <br /> Sample No. Sample Type Sample Volume Preservative Requested Testing Program Special Instructions <br /> 11 V91$1 '_50 I L ?"X6" BRAMT%M C-oox. 4 GC_ U + G SSZo <br /> r-F?f G SO 30 <br /> CHLorzAQXTE� 11"Ir 6LC 8010 <br /> I x WaD oe <br /> CA-P M c7Ais t Cd,CRS T6,Z i,N, <br /> CSS R,F= tom-- A cr2.QW715 <br /> TURNAROUND TIME REQUIRED: (Rus must be approved by the Laboratory Project Manager.) QC LEVEL: (Levels II and III subject to surcharge;project-specific requirements must be <br /> `` / submitted to lab before beginning work.) <br /> Normal + Rush (Subject to rush surcharge.) I J II III Project Specific <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 = Flammable Skin Irritant Highly Toxic Other <br /> _ (Please Specify) <br /> SAMPLE DISPOSI (Please Indicate_disposition_ofi sample following analysis._Lab will charge-iorpacking,shipping,archive.and disposal.} _ <br /> _ --- <br /> Return to Client Disposal by Lab ! Archive (Indicate number of months.) <br /> FOR LAB USEONLY _.. 14'01 <br /> Received by ..Date/Time ll'1/Jq) . ��S <br /> WHITE-Original,to accompany samples <br /> t26A-106s <br /> YELLOW-Fier copy <br />