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INTERNATIONAL ' <br /> r <br /> TECHNOLOGY <br /> CORPORATION k REQUEST"FOR ANALYSIS � <br /> PROJECT NAME <br /> RIA Control No. 2 3 0 1 2 <br /> pRc Jt'� CIC onlrol No,D� <br /> ECT NUMBER n}Q Z DATE SAMPLES SHIPPED Z —'�---- <br /> PROFIT CENTER NUMBER 3� LAB DESTINATION r r <br /> }� r1Gt n�.Q <br /> PROJECTMANAGER LSA EnJ LABORATORY CONTACT <br /> BILL TO ! -._a4 Cir SEND 018 REPORT 70 <br /> 4. <br /> PURCHASE ORDER NO. �— DATE REPORT'REQUIRED <br /> PROJECT CONTACT � Al � <br /> Sample No. ``• <br /> PROJECT CONTACT PHONE NO. 15 3_7Z-900 <br /> S'.yfo Type Sample Volume <br /> S5T- — L✓ j PreservativeI <br /> 5 D I �}e t .. Requested Testing Program <br /> 5.5T- ¢--�' Special Instructions <br /> 5 S T �— ytl T '� L r ' P <br /> SST 5- <br /> 5Sr �6-E _ <br /> 5.5 T `7 - E <br /> TURNAROUND TIME gEOUIRE� (Rush must be approved by the Laborato pr <br /> Normal ` rY oJect Manager.) OCLEVEL.- {Levels Il and III subject to s rrchar e; r <br /> 1 j Rush ",� 9 p oject-specific <br /> l �� _ (5ubjacl ton h surcharge.) t submitted to lab before beginning work.) requirements must be <br /> POSSIBLE HA7ARD fDENTiriCA'ION;` If <br /> (Please indicate if sampfe(s)are hazardous materials endlor sus 11l y_ Project specific <br /> Non-hazard I � <br /> I Flammable„ suspected to contain high levels of hazardous substances.) <br /> SAMPLE DISPOSAL: Skin Irrlt9nt ' F <br /> f (Please indicate srhon q - pig fapowing analysis.Lab w11!charge for packing,shipping,Haghly Toxic�� #44� <br /> Return to Client x Other s� y"EP <br /> Diar�i s'al .Lab archive end disposal.) (i4erse SpaUry) <br /> j FOR[AR USE ONLY Archive, (Indicate nun <br /> ber of months,} <br /> Recolt4d by <br /> r — fp <br /> WHITE-01, ldl miami <br /> li t "late/Tim yaI ysaaes(ELt _ 61 <br /> i l <br /> : <br /> F" <br /> 1' <br /> 'N <br /> a <br />