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INTERNATIONAL 178797 <br /> TECHNOLOGY REQUEST FOR ANALYSIS R/A Control No. <br /> CORPORATION C/C Control No. !I MS2 <br /> 1 PROJECT NAME nrt c_,F ;r . o DATE SAMPLES SHIPPED 061 <br /> PROJECT NUMBER 1112�� LAB DESTINATION <br /> PROJECT MANAGER r r' "J LABORATORY CONTACT <br /> BILL TO eC g I t !' SEND LAB REPORT TOrc��a,J �— <br /> P1 a �--i���e_���►a �i Y,S S 3 t.t.� C��s� Vic,r~.�i c.n��,,�; <br /> PURCHASE ORDER NO. DATE REPORT REQUIRED f)6 ` .1 C� <br /> PROJECT CONTACT I <br /> t PROJECT CONTACT PHONE NO. <br /> Sample No, Sample Type Sample Volume Preservative Requested Testing Program Special Instructions <br /> TURNAROUND TIME REQUIRED: (Rush must be approved by the Project Manager.) <br /> Normal Tt�— Rush (Subject to rush surcharge) <br /> POSSIBLE HAZARD IDENTIFICATION: (Please indicate if sample(s)are hazardous materials and/or suspected to contain high levels of hazardous substances) <br /> Nonhazard Flammable Skin irrltanl�— Highly Toxic Other <br /> pp (Please Specify) <br /> SAMPLE DISPOSAL: (Please indicate disposition of sample following analysis.Lab will charge for packing,shipoing,and disposal.) <br /> Return to Client Disposal by ab,41 i` I <br /> FOR LAB USE ONLY !�1�='' <br /> Re elvidBy f �' '�(=% � ��' �]J Date/Time <br /> WHITE-Original,to accompany samples <br /> YELLOW-Field copy �' <br />