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INTERNATIONAL U VJ UAI(�Control No. - <br /> TECHNOLOGY REQUEST FOR ANALYSIS CIC Contr No. 5 - <br /> CORFORA:'ION <br /> S G�{�p7 - DATE SAMPI-ES SHIPPER � �d�-- - <br /> PROJECT NAME `! - <br /> PROJECT NUMBER 111 Y LAB DESTINATION r S <br /> 1 <br /> PROJECT MANAGER 4-11 S. y— LABORATORY CONTACT <br /> BILL 70 7 / SEND LAB REPORT TO <br /> PURCHASE ORDER NO. DATE REPORT REQUIREDEE <br /> * i <br /> PROJECT CONTACT <br /> PROJECT CONTACT 6HCNE NO. <br /> Sample N. Sample Type Sample Volume Preservative Requested Testing Program Special Instnrctions <br /> r� <br /> G�i21�t7 -- <br /> 017 It �qie- <br /> r <br /> MAI <br /> • -L(�J G a ;� —�1V ;— p01.) i <br /> t <br /> frx 70 pelf,P I - --- <br /> TURNAROUND TIME REQUIRED: (Rush must be approved by the Project Manager.) <br /> Normal Ruah (Subject to rush surch?rge) <br /> POSSIBLE HAZARD IDENTIFICATION: (Please indicate if samples)are hazardous materials and/or suspected to contain high levels of hazardous substances) <br /> Northward Flammable Skin Irritant Highly Toxic <br /> (Ptrak SpacMy 1 s, <br /> N, <br /> SAIII E 151SPOSAL- 1Flease indicate disposiiSan of sample loltowir•.g analysis.Lab wil charge ter packing,shipping.and disposal I - @+ <br /> "i <br /> - _ Fletunn to Client –_ Disposal by La <br /> FOR LAS USE(ONLY t tiaselTlme ` � <br /> Received <br /> WHITE Ori tl.to accompany samples <br /> YELLOW Feld copy I r <br /> r <br /> „-. M <br /> � r <br /> a <br /> i <br /> t <br /> - . .. .» <br />