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"529"AAL= NO NO l -1i � 7 � <br /> OR/A Control No <br /> RORAMOINN PREQUEST k R ANALYSIS <br /> CIC Control No -XIOSB <br /> PROJECT NAME Qac=-;T-;c- 2 I j _ DATE SAMPLES SHIPPED <br /> PROJECT NUMBER 14 a04CLAB DESTINATION I <br /> PROJECT MANAGER wD., aiJ LABORATORY CONTACT St3e,n,,ln1 <br /> BILL TO y SEND LAB REPORT TO <br /> PURCHASE ORDER NO 1 Y80009 DATE REPORT REQUIRED nfa: - _ <br /> PROJECT CONTACT <br /> t <br /> PROJECT CONTACT PHONE NO _ q/S - A-f.-y r o n <br /> Sample No Sample Type Sample Volume Preservative Requested Testing Program Special Instructions <br /> O� O ► <br /> �Z co Q <br /> TURNAROUND TIME REQUIRED (Rush must be approved by the Project Manager) <br /> Normal Ift Rush XX- (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.A�k Flammable Skin Irritant%-AZA1 Highly Toxic Other <br /> (Please Specify) <br /> SAMPLE DISPOSAL (Please indicate disposition of sample following analysis Lab will charge for packing,shipping and disposal} <br /> Relum to Client pl�po�al by b <br /> FOR LAB USE ONLY <br /> Rece Date/Time <br /> WHITE-Original to accompany samples <br /> YELLOW-Field copy <br />