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®1A <br />OZ <br />®3 <br />6'1 <br />IM <br />• <br />El <br />IT <br />v v <br />REQUEST • ANALYSIS <br />- <br />PROJECT NAME PG.C;r, i Q, QQ11 <br />PROJECT NUMBER l q;(ogI. <br />PROJECT MANAGER f- "HIJOr) <br />BILL TO %$ <br />M +z 9 465-3 <br />PURCHASE ORDER NO. % 91 <br />DATE SAMPLES SHIPPED <br />LAB DESTINATION <br />LABORATORY CONTACT <br />SEND LAB REPORT TO <br />PROJECT CONTACT <br />PROJECT CONTACT PHONE NO. <br />Sample No. <br />Sample Type <br />Sample Volume <br />Preservative <br />Requested Testing Program <br />Special Instructions <br />y <br />t 1 t <br />® /� <br />Alex /r <br />N <br />da / <br />C. 22749Z <br />© it <br />TURNAROUND TIME REQUIRED: (Rush must be approved by the Project Manager.) <br />Normal X X Rush W (Subject to rush surcharge) <br />POSSIBLE HAZARD IDENTIFICATION: <br />Nonhazard X�k_ <br />(Please indicate if sample(s) are hazardous materials and/or suspected to contain high levels of hazardous substances) <br />Flammable <br />Skin Irritant <br />SAMPLE DISPOSAL: (Please indicate disposition of sample following analysis. Lab will charge for packing, shipping, and disposal.) <br />FOR LAB USE ONLY <br />Return to Client <br />Received By <br />WHITE - Original, to accompany samples <br />YELLOW - Field copy <br />Disposal by <br />Highly Toxic <br />Date/Time <br />Other <br />(Please Specify) <br />