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Cbtyton For C;-f*)11 U:a Q- Y P , — x. <br /> f ENVIRONMENTAL REQUEST FOR LABORATORY Project ri,) 3L140 , L9- <br /> CONSULTANTS ANALYTICAL SERVICES Batch No gt01 � <br /> A Minh E Mt l ennan Company Cbent No <br /> Dale Logged In t Is q DY <br /> O Name J br T j� �t a Title r ,� Pjrchase Order No Client Job Noy SND/At 6 <br /> �'�t r/. . r~� Gr t E' <br /> cr cn Company 0/ 4 !J ti" rt �" 0 t, �C Dept. C. t Name. � � <br /> a_ J Mailing Address ,x 0 v <br /> uJ C a z — O ornpan . >t r L v_. Dept <br /> cc w City, State, Zip ,c bac L � ~ Address V, <br /> cc Telephone No. ? <br /> P / ~ -,2(02 Telefax No. Cit , State, Z �' <br /> Data R sults 7quirea: ush Charges Authorized? Phone Results <br /> Samples are: N ANALYSIS REQUESTED <br /> O/ ❑ YesZ No ❑ Check if applicable) m (Enter an 'X'in the box below to indicate request, Enter a 'P'if Preservative added <br /> Special Instructions: (method, limit of del ction, etc.) <br /> Drinking Water <br /> � <br /> , rem (cl r �,h a r f L ❑ Collected in the <br /> Explana on of Preservative: /;/-y'-93 1 _ State of New York m <br /> DATE MATRIX/ <br /> AIR VOLUME E 1 FOR LAS <br /> CLIENT SAMPLE IDENTIFICATION SAMPLED MEDIA (specify units) Z �n USE ONLY <br /> Z/j wb/ L6ref' v Ol <br /> i <br /> CHAIN Relinquished by: 11,`-[ Date/Time Received by: Date.Time <br /> OF Relinquished by: Date/Time Received at Lab by: / DateZM1 -5 <br /> Qor-� <br /> CUSTODY Method of Shipment: Sample Condition Upon Receipt: Acceptable ❑ Other explain) <br /> Authorized by: Date <br /> (Client Signature s ccompany Request) <br /> i Please return to one o <br /> completed form and samples f the Clayton Environmental Consultants, Inc. labs listed below: <br /> P P - -- - <br /> DISTRIBUTION: <br /> j <br /> 22345 Roethel Drive Raritan Center 400 Chastain Center Blvd., N.W. 1252 Ouarry Lane WHITE Clayton Laboratory <br /> Novi, MI 48050 160 Fieldcrest Ave. Suite 490 Pleasanton, CA 94566 YELLOW Clayton Accounting <br /> (313)34.3-1770 Edison, NJ 08837 Kennesaw,GA 30144 (415).32E-2600 PINK Client Copy <br /> (201)225-6040 (404)494-7500 6r90 <br />