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INTERNATIONAL <br /> TECHNOLOGY REQUEST FOR ANALYSIS R/A Control No. <br /> CORPORATION <br /> ::. I 1 r� (� /1 yvt ��, C/C Control No. <br /> PROJECT NAME <br /> 1 i `1 `)C DATE SAMPLES SHIPPED <br /> PROJECT NUMBER LAB DESTINATION '/ / r S' <br /> PROJECT MANAGER VL,I IC GIA12n.� LABORATORY CONTACT %r(i'.Lt \A/�<_�`�� <br /> BILL TO _ I T - ��c rIv ai.i-'� ' tA11 Z. SEND LAB REPORT TO �- t <br /> � �lY1Ynr1'Y <br /> • I <br /> Il >f ° vILi 1'•n} e <br /> — I <br /> PURCHASE ORDER NO. <br /> — DATE REPORT REQUIRED %'I•`-�•�j• ►� <br /> PROJECT CONTACT t•1 k: (�y1 r/rl rl T I' it <br /> PROJECT CONTACT PHONE NO. <br /> II 1 <br /> Sample No. Sample Type Sample Volume Preservative Requested Testing Program <br /> =Speclal ., <br /> \ Pic P, <br /> a/�U" .-( 4V 1ni1 <br /> I <br /> TURNAROUND TIME REQUIRED: (Rush must be approved by the Project Manager.) i I ' <br /> Normal Rush t' (Subject to rush surcharge) 1 <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 ToxicOther Pc: jl rS <br /> SAMPLE DISPOSAL: (Please Indicate disposition or 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 -Y-1 j-."r •I I -:. Date/Time <br /> �. <br /> WHITE-Original,to accompany samples <br /> YELLOW-Field copy I - <br />