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r . <br /> I j INTERNATIONAL 276002 <br /> TECHNOLOGY R/A Control No. <br /> I CORPORATION t: REQUEST FOR ANALYSIS I <br /> C/C Control No. <br /> PROJECT NAME F)rzr—FI I-A tJt t DATE SAMPLES SHIPPED <br /> PROJECT NUMBER I9 0g9Z LAB DESTINATION f_ r t� t_1 /fir•,X11 yl 1,� ,it <br /> r <br /> PROFIT CENTER NUMBER LABORATORY CONTACT it I k•L4, 1 <br /> PROJECT MANAGER &�A►J Ll y NNL SEND LAB REPORT TO <br /> BILL TO L.1- Colc(�, tl '� I H�ECc tLVt <br /> r���� ���1C�I E CO �L�/D � ►`'�A f,�"1 I►J F� C � <br /> f--IA IZ'T +NE z. CA . DATE REPORT REQUIRED <br /> PURCHASE ORDER NO. PROJECT CONTACT 4 I�Q LAJYI.I'►.J L <br /> PROJECT CONTACT PHONE NO. C L C,� 100 <br /> Sample No. Sample Type Sample Volume Preservative Requested Testing Program Special Instructions <br /> - <br /> TURNAROUND TIME REQUIRED: (Rush must be approved by the Laboratory Project Manager.) OC 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 / 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 DISPOSAL: (Please indicate disposition of sa 6 following analysis.Lab will charge for packing,shipping,archive and disposal.) <br /> Return to Client Disposal by Lab Archive (Indicate number of months.) <br /> FOR LAB USE ONLY 'G Q 1 3_'?14 <br /> Received by Date/Time ( I Yt <br /> WHITE-Orir. ko accompany samples <br /> • 126A-10w5 <br /> PELL fiela •• j j 1 j R 1 f I j <br /> 1 <br />