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f• - ;�� - � Y!j <br /> I k, , <br /> - <br /> s A. <br /> INTERNATIONAL <br /> TECHNOLOGY RIA Control No. 2301005 <br /> CORPORATION REQUEST FOR ANALYSIS ,- . <br /> l / C! Control No. � !�— � <br /> PROJECT NAME i �_`'I'l'r� l!�' DATE SAMPLES SHIPPED <br /> PROJECTIAUMBLR � Jb~s LLAB DESTINATION 1119 l 1;lJ !�� I , 1 �r4 <br /> PROFIT CENTER NUMBER^-�- � 1 <br /> LABORATORY CONTACT <br /> PROJECT MANAGER r ' ! +�L SEND LAB REPORT TOc ny)t�_Q <br /> BELL TO r` ✓�• ? : r <br /> !! <br /> I,�f��n II <br /> vii - r <br /> j ) <br /> DATE REPORT REQUIRED <br /> PURCHASE ORDER NO. PROJECT CONTACT <br /> PROJECT CONTACT PHONE NO. 5 ?� - a}!lE _ <br /> Sample No. Sampie'Cype Sample Volume Preservatiii Requested Testing Program Special insiru lions <br /> f •rr1c, t L4, f,N s :j It <br /> s <br /> Flor <br /> „�� j='r <br /> I Al, <br /> r { <br /> TURNAROUND TIME REOUIRED: {Kusa must be approved by the Laboratory Project Manager.) OC LEVEL: (leevels II and!II subject to surcharge;project-specific requirements must be <br /> submi!led to fab before beginning work.) <br /> Normal Rush (Subject to rush surcharga.) I _ II III Project Sp,�ciflc <br /> POSSIBLE HAZARD IDENTIFICATION: (Please indicate it sample(s)are hazardous mat(?ria*--and/or suspected to contain high levels of hazardous substances.) <br /> � 3 <br /> Non•hazarrSi Flammable Skin lrritent Highly Toxle_ Other ' <br /> (Pleeae Specify) <br /> SAMPLE DISPOSAL: (Please indicate disposition of sample following analysis:Lab will charge for packing,shipping,wrhlve and disposal.) <br /> l <br /> Return to Client <br /> Disposal by Lacs Archive _(Indicate number of months.) 1&. <br /> FOFLAB USE ONLY <br /> Received by ( ;_ t �;� DatelTime <br /> 1 f <br /> WHITE-Ony <br /> _ o.. accmpany samples o1....- v <br /> ra.1aa5.ELeldc. I, <br /> i <br /> j l 'F <br /> - i <br />