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an - <br /> �I %.r. <br /> v <br /> 1NTMATIONAL 2 3 0 0 7 <br /> 1'ECHlA Control No. <br /> ANAhY�!S 110LOGY f� <br /> COMRAnOAf r REQUEST FOR <br /> t.• l i Cl (Control No. 06 r�U <br /> PROJECT NAME; DATE SAMPLES SHIPPED <br /> PROJECT NUMBER ` o l �� _ � f <br /> ���_ y LAB DESTINATION q <br /> PROFIT CENTER NUMBER I LABORATORY CONTACT r)c.AV- <br /> PROJECT MANAGER SEND LAB REP01?T TO <br /> BILL TO <br /> � J� C Jtr.4 I's liv�4 ` <br /> DATE REPORT REQUIRED r <br /> PURCHASE t}tir)ER NO. PROJECT CONTACT <br /> PROJECT CONTACT PHONE NO.C� � ?' <br /> Sample Na Sample - x a <br /> Type Sample Volume Preservative Requested Tosting Program <br /> Special Instructions <br /> 68 <br /> AJ <br /> I <br /> TURNAROUND TIMEREOUIRED: Rush must be approved pproved by the Laboratory Prc)ect Manager.) QC LEVEL: (Levels II and III subject to iwrtherge;project-specific requirements must be <br /> submitted to tab before beginning,nork.) d ^t <br /> Normal Rush (Subject to rush surcharge.) I 11 Ill Pralect Specific B <br /> POSSIBLE HAZARD IDENTIFICATION: (Please indicate if sample(s)are hazardous materials andfor suspected to contain high Iwals of hazardous EubsLnces.) <br /> I e i <br /> Non-hazard Ft3mniafzle Skinlrritarit - HlghlyTaxlc,.•_— Other <br /> i (Please wry) <br /> SAMPLE DISPOSAL:I (Please indicate dispositionoffImple following analysis.Lab will charge far packing,shipping,archive and disposal.) <br /> i 7 <br /> Return to Client Disposal by Lab— +� Archive (Indicate number of months.) <br /> FOR LAB USE ONLY.j Received LZAQ! p(�c7 I 5 l✓I, r <br /> t 1 by Date/Time <br /> -0 WHITE-Ori to a=' mpany samples ` l{ <br /> 'ELLLri : ;field <br /> r y . <br /> ..y <br /> _ f <br />