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INTERNATIONAL y <br /> TECHNOLOGY RIA Control No. 2 I D12 <br /> CORPORATION REQUEST FOR ANALYSIS <br /> C11-Conlro)No.�t•�?JJ <br /> __. PROJECT NAME �� –`'1Jr �C T 1 _ DATE SAMPLES SHIPPED <br /> L—T <br /> PROJECT NUMBER LAB DESTINATION <br /> PROFIT CENTER NUMBER / f – LABORATORY C0TACT �– <br /> �c,r -'�'o ', r••_ , ���� !-, <br /> PROJECT MANAGERSEND LAB REPORT TO'J�r /1 1 } ' <br /> I <br /> BILL TO 't C� _ � —� � f � <br /> >,j H ..f�vl� � { rl 'r3 Ili�V '� --. •�_.-'-- .._._r—/1 - � kLr��.�r, <br /> DATEREPORT REQUIRED <br /> -- ;� <br /> OURCHASE ORDER NO. PROJECT CONTACT <br /> — PROJECT CONTACT PHONE NO. =�4I)�! n ' .41 <br /> 5ampie No 5aTrple Type Sample Volume Preservai,Ne �— Requested Testifig Prnysan•, Special Inslrucl,ons <br /> .i 77l ` 1. yrG, Ir {-•� <br /> � �Sr. S_'_ �r —1 ,,- �` 'c �1`�c��•:/nq�,s•.c {`�11,15� • '�;_ <br /> Se j <br /> } I1 <br /> TURNAROUND TIME AEOU1RED, (R=mus!be approved by the Laboratory Project Manager,) OC LEVEL: (Levels P and!11 Sutrrdcl to surcharge;project s0ec0iL requirernenls must he +:•ijt <br /> �., suhmitled to lab before beginning work.) - ;3- <br /> a sl. <br /> Normal Rush {Subject to rush surcharge,} I it !il Project Specific r <br /> -' ' <br /> PD55`BLE HAZARD IDENTIFICATION: (please indicate is samplc{s)are hazardous maloriais and/or suspected to contain high levels of hazardous substances.} <br /> Non-hazard Ftammable Chin Irritant__T Highly Toxic Other <br /> (Please Speeiry) <br /> SAMPLE D15POSP1: (Please indicate dispassion oi�aq+plo ol;awing analysis,Lab will chance for packing,shipping,archive and disposal.} <br /> s ;.sArgJ; <br /> Return to Client Disposak-%y_Lab Archive (Indicate number of months.) t s ? <br /> FOR LAB USE ONLY <br /> Received by Date/Time �• F <br /> � a <br /> WHITE-Origij ,accarnpany samples zer,gas <br /> YELLOW-Field cnpy <br />