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y _ <br /> INTERMATIONAL <br /> TECEENOLOGY RIA Control No. 2� -1 U 6 F <br /> I'V2OIRMON REQUEST FQ�A ANALYSIS <br /> GIC Control No. <br /> PRO.JECTNAME <br /> DATE SAMPLES SHIPPED <br /> X PROJECT NUMBER � 1�)t: .` LAB DESTINATION � r ilii') �� +I lie.r.. i <br /> PROFlT CENTEF-NUMBER ���� � LABORATORY CONTACT <br /> PROJECT MANAGER `-_n i J 1v••4 SEND LAB REPORT TO <br /> B;l,t TO C' I <br /> Ve <br /> DATE REPORT REQUIRED <br /> r. PURCHASE ORDER NO. PROJECT CONTACT / �✓' Lv� +'!^". <br /> PROJECT NTA C1 3�i <br /> PR CT CO CTPHONE NC>. <br /> Sample No. I Sample Type Sample Volume Pr,4sarvative taequasted Te�irg ProgramSr' lInsbuctiorm <br /> r <br /> F-- 577- <br /> - I 5�)i :�,� •X 6 1 �� 1: <br /> - <br /> S55_ 2- <br /> . � i ♦ r\a � y <br /> PIZ{0L. a n <br /> 55_ .x} CD8 �n <br /> s5 � h <br /> - 12— <br /> IT <br /> rz RCS . r <br /> lb �I <br /> TURNAROUND TIME REQUInED: (Rush must be approved by the Laboratory Prgtct Manager.) OC LEVEL: (Levels 11 and III subject to surcherp.project-specific requirements must be <br /> • submitted to tab before bogemeLig work-) <br /> Normal Rush __ (Subject to rush surcharge.) I 11 m project Specift <br /> I <br /> POSSIBLE HAZARD IDENTIFICATION: 'Please indicate if sample(s)are hazardous materials andira suspected to contain high levels of hazardous substances.) k=' <br /> Non-hoxard Flammable skinirf'ant HlghlyTorric, father <br /> rk <br /> SAMPLE DISPOSAL: . (Please indicate disposition of mpla following analysis.Lab will charge for packing,shipping,archive and dr�csal.) ( sae*htl <br /> Return to Cltant i Disposal by Lab r � Ar+chlve (indicate number of months.) slit <br /> i <br /> FOR LAB USE ONLY e a J <br /> q I. Recelved by DsielTime 4()f1 5 <br /> WHITE-Onr !to accompanysampxs r�snaoas <br /> ie1d t <br /> i.._ _ .. ... ., <br /> .f. <br /> It <br /> c , <br /> l�' <br />