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I: <br /> .. �I, - - - <br /> iuT1iN13'rc"7l RL 2 3 Q Q fl 3 <br /> UCANOLOGY RIA Control No. <br /> CO�tFORA'i'iON REQIIEST.FOR ANALYSIS <br /> j [ l Cor,trot No. <br /> PROJECT NAME `.. 'ToY1DATE SAMPLES SNIPPED � 19/91 <br /> PROJECT NUMBER `) 3 2— LAB DESTINATION <br /> PROFIT CENTER NUMBER 3 LABORATORY CONTACT IA d, t <br /> k PROJECT.MANAGER 401 �l.�i'lYrl1l�_ _ SEND LAB REPORT TO <br /> BILL TO <br /> 45,i !ernCk,(a Fid � <br /> DATE REPORT REQUIRED <br /> PURCHASE ORDER NO. ROJECT CONTACT 1-1/1 <br /> PROJECT CONTACT PHOMe NO. _r, +) /Z.' 110 <br /> Sample No, 1 Sample Type Sample Volume Preservative Requested Testing Program Special Instructions <br /> - 4•yK-77-3 - <br /> HTpfl F0, <br /> SIS '��-5 rd • <br /> Lti) <br /> yr:__ <br /> r <br /> �j <br /> 544- <br /> TURNAROUND TIME REQUIRED:' (Rush_must be approved by the Laboratory Project Manager.) OC LEVEL: (Levels 11 and 111 subject to surcharge;project-specihp requirements must be <br /> 1(' submitted to tab before beginning nark.) <br /> Normal Rush,;.' (Subject to rush surcharge.) I i1 I}I pmt Specific r <br /> POSSIBLE HAZARD IDENTIFICATION: {Please In(";c'e if sample($)are hazardous materials andlor suspected to contain high levels of hazardous substances.) ;. <br /> Non-hazi rd r Flammable Skin Irritant <br /> HighlyToxic Other <br /> . ( 5th)-SAMPLE DISPOSAL: position al sample following analysis.!ab will charge for packing,shipping,archive and disposl.){ lease indicate d:- <br /> Return to Client Dlspoii 1 by Lab _ Aichlvd (Indicate number at months.) <br /> FOR LAB USE ONLY <br /> _.- Received by <br /> WHITE=Oriy, (to accompany samples }Y <br /> �.... - ELLQ. <br /> 'j <br /> i _ z <br /> A <br /> tea.�.— —- - _.•_.� - - - - -�. <br />