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i <br /> � L <br /> l a" <br /> � r <br /> INTERNATIONAL <br /> TECHNOLOGY RIA Control No. 230011 <br /> coRpoRATioN REQUEST FOR ANALYSIS <br /> CIC Control No, SO 770 2 <br /> PROJECT NAME DATE SAMPLES SHIPPED <br /> PROJECT NUMBER _1 1063Z- d <br /> -- LAB DESTINATION rin <br /> PROFIT CENTER NUMBER 3�� � <br /> LABORATORY CONTACT <br /> PROJECT MANAGER nitSEND LAB REPORT TO <br /> BILL TO i �. <br /> L S Pa (3 d. <br /> Mar1710 C-A 94553 <br /> DATE REPORT REQUIRED <br /> PURCHASE ORDER NO. PROJECT CONTACT <br /> PROJECT CONTACT PHONE NO. <br /> Sample No. i Sample Type Sample Volume Preservative <br /> Requested Testing Program Spode!Instructions <br /> 5 T-0- 1 <br /> dam. _�-- <br /> 7- 0 <br /> s.5 T-4 - 4 <br /> l I� <br /> 5T- <br /> i <br /> TURNAROUND TIME REQUIRED_ Rush must be approved by the laboratory Project Manager.) QC LEVEL- (Levels II and III sub ect to surcharge; r ect-s <br /> 1 9 Pal peckiic raqufremonts must be <br /> Normal --��{UST submitted to lab before beginning work.) <br /> --�__ (Subject to rush surcharge.) 1 111 1111Project Speclffc 5` g <br /> POSSIBLE HA7ARD IDENTIFICATION:ON: (Please indicate if sample(s)are hazardous materials and for suspected to contain high levels of hazardous substances.) I I <br /> Non-hazard� Flammable <br /> Skin Irritant NZ Highly Toxic Other <br /> SAMPLE DISPOSAL: (Please fndicate disposition of sample following analysis.Lab will charge for (Please Specify) <br /> j 9 packing,9.shlPPing,archirA and disposal.) <br /> Return to Client 1 Disposal by Lab Amhlve (indicate number of months.) <br /> FOR LAB USE ONLY <br /> Received by <br /> r Date/Time <br /> WHITE-Orqi,to accompany samples <br /> ELL( eldc[.-I <br /> tF <br /> �til <br /> t ( <br />