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1J9 <br />PROJECT NAME Pct,C-;T- "r— c l <br />PROJECT NUMBER <br />PROJECT MANAGER o^) <br />BILL TO KeC .plc- s' <br />PURCHASE ORDER NO. ! Y8099 <br />DATE SAMPLES SHIPPED <br />LABORATORY CONTACT <br />SEND LAB REPORT TO <br />DATE REPORT REQUIRED <br />PROJECT CONTACT <br />PROJECT CONTACT PHONE NO <br />R/A Control No. 1 <br />78797 <br />C/C Control No. 11112,S2 <br />Sa(m�ple No. <br />Sample Type <br />Sample Volume <br />Preservative <br />Requested Testing Program <br />Special Instructions <br />®[ <br />(--c, <br />a <br />Tey (�2 <br />del i2A <br />TURNAROUND TIME REQUIRED: (Rush must be approved by the Project Manager.) <br />Normal Rush 2< 'A— (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 YA Flammable Skin Irritant Highly Toxic Other <br />SAMPLE DISPOSAL: (Please indicate disposition of sample following analysis. Lab will charge for packing, shipfg, and disposal.) <br />Return to Client Disposal by b,:a / <br />FOR LAB USE ONLY <br />Rece`ivilid Bi <br />Date/Time <br />/ <br />WHITE - Original, to accompany samples ' <br />YELLOW - Field copy �' <br />(Please Specify) <br />