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INTERNATIONAL _) 9 7 <br /> TECHNOLOGY REQUEST FOR ANALYSIS 53328 R/A Control No. r <br /> CORPORATION C/C Control No. <br /> PROJECT NAME DATE SAMPLES SHIPPED <br /> PROJECT NUMBER LAB DESTINATION <br /> PROJECT MANAGER LABORATORY�. LABORATORY CONTACT <br /> BILL TO Ct>rf SEND LAB REPORT TO <br /> "11-15ty a s v <br /> nnc. C <br /> PURCHASE ORDER NO. __. 1 (d ld k DATE REPORT REQUIRED 456 V ,6-,. ,S-(Z-Q <br /> PROJECT CONTACT �r <br /> PROJECT CONTACT PHONE NO. <br /> Sample No, <br /> INo, Sample Type Sample Volume Preservative Requested Testing Program ` Special Instructions <br /> K � � L JAS `rid y1 r7�tt� Zft, aC �aU_� �¢�Yo�tww r�rOC[.b�x <br /> Are <br /> Soap �!,o7.r3 �ol� <br /> Sle�w� x <br /> k (scx <br /> Sb3c $oZtco <br /> br e l_t.td toll D <br /> TURNAROUND TIME REQUIRED: (Rush must be approved by the Project Manager l <br /> ✓ <br /> Normal 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 Irritant Highly Toxic Other (�! �'f4 t'0 "��✓ <br /> (Please Speclty) <br /> SAMPLE DISPOSAL: (Please indicate disposition of sample following analysis.Lab will c arge for packing,shipping,and disposal.) <br /> Return to Client Disposal by Lab <br /> FOR LAIC USE ONLY <br /> Received By Date/Time <br /> WHITE-Original, to Accompany samples <br /> YELLOW- Field copy <br />