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I . <br />� � � 4fi I •r <br /> 1 <br /> :'.,;:LS a•.: - <br /> :., m <br /> 1 <br /> �1 <br /> ERNATIONAL <br /> TECANOI.OGY RIA Control No. 2P 3 J a.4 ' <br /> TE <br /> COMRMON. REQUEST.FOR ANALYSIS �rJ <br /> CIC Control No.-- <br /> PROJECT NAME DATE SAMPLES SHIPPED 1 & <br /> PROJECT NUMBER LAB DEsI INATION <br /> PROFIT CENTER Nt!MBER _._-_. 44 LABORAV3W CONTACT <br /> PROJECT MANAGER / <br /> SENDLAB REPORT TO f <br /> 61LL;Ip rt r3Y yy , <br /> Af bi-i rA 45 s"s DATE REPORT REQUIRED A k i <br /> PURCHASE ORDER NO. PROJECT CONTACT <br /> PROJECT CONTACT PHONE NO. -`� " <br /> Sample Na Sample Type Sample Volume Pr65ervativo Requested Testing Program Special Instructions <br /> 2 <br /> r <br /> 55� 7 ai <br /> S5 <br /> .r t• <br /> TURNAROUND TIME REQUIRED: (tush must be approved by the Laboratory Project Manager.) OC LEVEL: (Levels 11 and III subject to surcharge;project-specific requirements must be 4� <br /> submitted to lab before beginning work.) <br /> Normal I -ituslt -\ (Subject to rush surcharge.) f 11 [Il Protect Specific <br /> POSSIBLE HAZARC IDENTIFICATION:- ' — (Please indicate if sample(s)are hazardous materials and f or suspected to contain high levels of hazardous substances.) <br /> Non-hazard Skin Irritant Highly Totrlc Other <br /> ! <br /> SAMPLE DISPOSAL: (Please irxCxate d*Positfor�ol cKmpfe following analysis.Lab will charge for parking,shipping,archive and disposal.' (Please SPeciry) <br /> Retumto Client Dios by Lad y Archive (ndkate nun trot month&) <br /> FOR LAB USE ONLY - <br /> Remhmdbr <br /> WHITE-Oriy floaccompanysamples <br /> i _•,..ELLC�-...._field � .. ( ! - ( _ _ :zw•,as. <br /> I <br /> I t ! <br /> .. r <br />