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I <br /> - : rR{ <br /> j <br /> - -. 7 <br /> _ INTERNATIONAL <br /> & . <br /> TECHNOLOGY j�:q <br /> CORPORATION REQUEST FOR ANALY i � RIA Control No. 2 7 <br /> SS <br /> CIP Cont n)No. _ <br /> PROJECT NAME 5+aJ(�m DATE SAMPLES SHIPPED <br /> PROJECT NUMBER 0�7� a t <br /> LAB DESTINATION <br /> PROFIT CENTER NUMBER 3 S`�I _ LABORATORY CONTACT <br /> PROJECT MANAGER �+> W v>,�L <br /> ,T SEND LAB REPORT TO <br /> I BILL TO CJY a` <br /> a r ►tel �S 3 DATEe <br /> REPORT REQUIRED Z L7 P1 I i <br /> I URCHASE ORDER NO. }I <br /> PROJECT CONTACT <br /> PROJECT CONTACT PHONE NO. I 3" 2- <br /> - <br /> Sampfe No. Sample rypip Sample Volume Preservative R �. <br /> equested Testin Pt ram <br /> B og S Special Pec , <br /> 55 <br /> 575 - <br /> 55- r <br /> _ 5 <br /> TC a- all 0,01 P)TE <br /> 54 i 6Tr- t (&Q 15. Tek , . <br /> s IU w IX <br /> p- ii t1 Z c�l�rin' Cd Ct v% b, <br /> - _ <br /> _ l <br /> TUR ttlyt3 Ti1Gf Rush must be a 4 a�' <br /> pproved by the Laboratory Project Manager.) QC LEVEL: (Levels II and III subject to surcharge;prolect-specific requirements must bo r <br /> No7ie1 / submi,ted to fato before beginning work.) <br /> (Subject to rush surcharge.) I V _ fl III Pro]ecl Specific <br /> POSSIBLE HAZARD IDENTIFICATION: (Pisase indicate If sample(s)aro hazardous materials andlor suspected to contain high levels of hazardous substances.) t ( <br /> Non-hazard Flammable_ <br /> Skin irritant�_ Night, Toxic 011ier <br /> SAMPLE DISPOSAL: (Please indicate disposition of sample following analysis.Lab wilt charge for Packing,shipping.archive and disposal.) (Please Specify) <br /> Return to Client <br /> Disposal by Lab Archive L_(indicate numbs of month ,) <br /> _ FOR LAB USc QNLY ' , r �� <br /> Received byDate ITime <br /> I + <br /> WHIT Ori at to acl <br /> �_ !.g comlany samples , <br /> ELL j:ield c r w <br /> .-.. <br /> s ; <br />