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® INTERNATIONAL g1110"2 L{ <br /> TECHNOLOGY REQUEST FOR ANALYSIS R/A Control No. 276056 <br /> CORPORATION 4 C/C Control No. ZCs5 1 <br /> PROJECT NAME -_?S�7 '-s w ) DATE SAMPLES SHIPPED 1 k ks l c1 <br /> PROJECT NUMBER IaCI9119LAB DESTINATION I-II 71_X <br /> PROFIT CENTER NUMBER ?j542 LABORATORY CONTACT <br /> �' I ' �/s1e <br /> PROJECT MANAGER �VM,�l\S ++ SEND LAB REPORT TO <br /> BILL TO 4S85 n hQCCh .1( A <IS�S_�lC� CO 1�Jc1 <br /> M±z on. aa55?3 VA-T-7-- <br /> DATE <br /> A-T-DATE REPORT REQUIRED It I bIA I <br /> PURCHASE ORDER NO. PROJECT CONTACT -t>J8 0Q_v <br /> PROJECT CONTACT PHONE NO. CAIS') x" ? -q 101(1 <br /> Sample No. Sample Type Sample Volume Preservative Requested Testing Program Special Instructions <br /> IG4 ' 1r1 1d t � PN (✓ G 1 *7,4T ' r <br /> OCG 1 l9 a c r to J <br /> 11 <br /> 1 <br /> ( r <br /> 1 1 <br /> TURNAROUND TIME REQUIRED: (Rush must be approved by the Laboratory Project Manager.) QC LEVEL: (Levels 11 and III subject to surcharge;project-specific requirements must be <br /> submitted to lab before beginning work.) <br /> Normal Rush_.JC (Subject to rush surcharge.) I II III Project Specific <br /> POSSIBLE HAZARD IDENTIFICATION: (Please indicate if sample(s)are hazardous materials and/or suspected to contain high levels of hazardous substances.) <br /> Non-hazard_-X Flammable Skin Irritant Highly Toxic Other <br /> SAMPLE DISPOSAL: (Please indicate disposition of sample following analysis.Lab will charge for packing,shipping,archive and disposal.) (Please Specify) <br /> Return to Client Disposal by Lab Archive (Indicate number of months.) <br /> FOR LAB USE ONLY <br /> Received by Date/Time <br /> WHITE-Original,to accompany samples IzsA-ic-es <br /> vri I hW-CI.IA n " <br />