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IN1 iRNATIONAL ; ,-J t,k <br /> TECHNOLOGY REQUEST FOR ANALYSIS R/A Control No. <br /> CORPORATION C/C Control No. `?/ l <br /> PROJECT NAME ( r'A-,'A DATE SAMPLES SHIPPED ! i�w <br /> PROJECT NUMBERLAB DESTINATION �r ✓r L~�2t?.� <br /> PROJECT MANAGER lit" '�'� LABORATORY CONTACT <br /> BILL TO t-2 r i r _1 '_i SEND LAB REPORT TO �Y�, ''� <br /> 1 1 E rrZ �t t t/.�, <br /> j`E 1s iiea D) 6 <br /> o r-Ili-, e t- <br /> PURCHASE ORDER NO. DATE REPORT REQUIRED <br /> PROJECT CONTACT <br /> PROJECT CONTACT PHONE NO. <br /> Sample No. Sample Type Sample Volume Preservative Requested Testing Proµgra/mtJ1 Special Instructions <br /> 'iii) ) .� i •� �� �)I{l..�r ' Or <br /> .i� f/l.'� , '' i.J✓r.'. - •xKjµ� "'i�` ;,f�L�'��-n ;; <br /> J N1 <br /> 1 '.1 <br /> ''l��,!�.; �� I #; •.,�'«..�..:-yam � <br /> / K 1 <br /> i I <br /> IlNJ <br /> i SI t ) <br /> TURNAROUND TIME REQUIRED: (Rush must be approved by the Project Manager.) <br /> Normal I"'`r Rush (Subject to rush surcharge) <br /> POSSIBLE HAZARD IDENTIFICATION: (Please indicate if sample(s)are hazardous materials and/or suspected to contain high levels of hazardous substances) <br /> 1,- <br /> Nonhazard Flammable Skin Irritant Highly Toxic Other <br /> (Please Specify) <br /> SAMPLE DISPOSAL: (Please indicate disposition of sample following analysis.Lab will charge for packing,shipping,and disposal.) <br /> Return to Client Disposal by Lab �•' <br /> FOR LAB USE ONLY <br /> Received By�'L'y.C.Ew"� �rl C.t, _ . Date/Time <br /> WHITE-Original,to accompany samples �— <br /> YELLOW-Field copy <br />