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INTERNATIONAL <br /> TECIINOLOGCORPORATION <br /> QUALITY-CONTROL <br /> � CORPORATION <br /> SAMPLE INFORMATION FORM <br /> JOB NAME: C SAMPLE I.Q.# <br /> J013 NUMBER: , Z,QQ,00,40 LOCATION: <br /> QA TYPE: L' <br /> DATE/TIME TAKEN: -9 - <br /> METHOD: <br /> SOURCE: etZ-z <br /> LOT NO.: . ' A'e, <br /> 4 PRINT NAME: zApir1w = PRINT NAME: <br /> SIGNATOR � SIGNATURE: <br /> iLJ <br />