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. r <br /> I <br /> INTERNATIONAL <br /> TECHNOLOGY <br /> CORPORATION 230013 <br /> _.._ REQUEST FOR ANALYSIS R/A Control No. <br /> p <br /> CI <br /> PROJECT NAME t7,. EC'Control No. �, -7 ', <br /> DATE SAMPLES SHIPPED �r <br /> PROJEC'T NUMBER i t� h':7 �1i t <br /> LAE DESTINATION h 401.�+ <br /> PROFIT CENTER NUMBER 3 J ' 1 .I <br /> � LABORATORY CONTACT _���N✓�r-t.:r/' l�+:� I��: i z' °t <br /> PROJECT MANAGER D rn, �✓ , h� <br /> _ r r )�' _ SEND LAB REPORT TO �� " <br /> BILL IV <br /> ! DATE REPORT REQUIRED <br /> 'URCHASE ORDER NO. PROJECT CONTACT r� !.f SLI <br /> PROJECT CONTACT PHONE NO. �`?? 7 <br /> p1 I <br /> Sample No. Sample Type Samp+e Volume Preservative Aequestcd Testing <br /> �VJ t ] 1 9 Program <br /> Speciallnstructions <br /> !. �1 Yr r ♦/ 111. ..♦ ~L -.(� i-� }I <br /> 10 T- <br /> e%is >> , <br /> i <br /> TURNAROUND TIME RE•LUAED. tush must be approved by the Laboratory Project Manager.) OC LEVEL: (Levels II and III subject to surcharge;project-specific requirements must be <br /> Normal i Rush ` submitted to lab before beginning work.) <br /> __–_. 1 (Subject to rush surcharge.) I If- <br /> Ill- Project Specific <br /> POSSIBLE HAZARD IDENTIfC7fl:DN: (Please indscale it sampte(s)are hazardous materials and/or suspected to contain high levels of hazardous substances.) <br /> Non-hazard Flammable <br /> Skin trritant Highly Toxic Other i <br /> SAMPLE DISPOSAL: (Please indicate disposition oa for f gample following analysis.Lab will char packing, (Please Sptdty) ' <br /> g P g.shi pping•archive and u+poral.) <br /> Return to Client Disposal by Lab�' '}_` Archive (Indicate number of months.) <br /> FOR LAD USE ONLY -- —– <br /> Received b <br /> y- <br /> i Date/Time <br /> WHITE•Ori :o accoaraany samples <br /> YELLOW-Fieru.opy <br /> SA 1()es <br /> I' <br /> 0111 <br /> mom <br /> I <br /> j <br />