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INTERNATIONAL 0 <br /> TECHNOLOGY R/A Control No. <br /> CORPORATION REQUEST FOR ANALYSIS C/C Control No. <br /> PROJECT NAME �/ G %�'u ��`z2 DATE SAMPLES SHIPPED ��/'��/s <br /> PROJECT NUMBER _ LAB DESTINATION S <br /> PROJECT MANAGER /'f�' r,� ?,q lIpr LABORATORY CONTACT <br /> BILL TO 7? ' ..YL2.r /✓/c. '% <� 1/ SEND LAB REPORT TOT <br /> ,�-�c y-_.�/tet-l��, �lC� ✓"'rl rl E'�- <br /> PURCHASE ORDER NO. DATE REPORT REQUIRED <br /> PROJECT CONTACTf1' ,J�-t <br /> 7 <br /> PROJECT CONTACT PHONE NO. <br /> t <br /> Sample No. Sample Type Sample Volume .Preservative Requested Testing Program Special Instructions <br /> _ :c._ t �i✓:[' / J- .'i �L7rY• 1 f/b !,/ � —C'C'ciC� �//:�.- fC./•.:.�, <br /> , <br /> TURNAROUND TIME REQUIRED: (Rush must be approved by the Project Manager.) <br /> Normal E 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 /> 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 k {'Y % " '"`' - Date/Time <br /> WHITE-Original,to accompany samples <br /> YELLOW-Field copy ,. r <br />