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INTERNATIONAL <br /> TECHNOLOGY REQUEST FOR ANALYSIS R/A Control No. 1 I a j <br /> CORPORATIONC/C Control No. Z b5 13Q <br /> PROJECT NAME �pe-I ����cj 'J DATE SAMPLES SHIPPED I O 131 l q I <br /> PROJECT NUMBER LAB DESTINATION <br /> PROJECT MANAGER LABORATORY CONTACT H C hoc _Z <br /> BILL TO 45gs-5 aty.Q hP O d --aIvCI SEND LAB REPORT TO <br /> N1Tz r gq�,S3 as c z A <br /> M_T Iz Cq g455 f) <br /> PURCHASE ORDER NO. DATE REPORT REQUIRED i�s»J I I q I <br /> PROJECT CONTACT m <br /> PROJECT CONTACT PHONE NO. (AIS) <br /> Sample No. Sample Type Sample Volume Preservative Requested Testing Program Special Instructions <br /> —1 -P N CST T N, -c�r �4�aua <br /> I 4+01 I Q-a ~Sol0Ic>1 Q . lead <br /> T <br /> IONCT(Ae�-z <br /> 10 <br /> 1 Tq 1 <br /> TA <br /> CSf4� <br /> Tq <br /> TURNAROUND TIME REQUIRED: (Rush must be approved by the Project Manager.) <br /> Normal Rush X (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 <br /> (Flew specify) <br /> SAMPLE DISPOSAL: (Please indicate disposition of sample following analysis.Lab will charge for packing,shipping,and disposal.) <br /> Return to Client Disposal by Lab <br /> FOR LAB USE ONLY <br /> Received ey oaternme <br /> 1 ^' F1r--- <br /> WHITE-Original,to accompany samples c.IVVIh'iil�Pl/IEIVFAL NtnLTH <br /> YELLOW-Field copy PERMIT/SERVICES <br />