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C'MytonFor Clayton Use Only P,ide o <br /> ENVIRONMENTAL REQUEST FOR LABORATORY Prosect No <br /> CONSULTANTS ANALYTICAL SERVICES Batch No. 3 <br /> A Manh b Nit tennan Company Client No <br /> Dale Logged In L ) I By <br /> i O Name �- Title Purchase Order No. Client Job No 3 -390 <br /> [1= r Company Deft ui Name <br /> a J Mailing Address p U <br /> a` city. State, Zip w C p ampany De l <br /> > Address <br /> 11� Telephone No. Telefax No. <br /> � lCity, State, Zi <br /> Date Results Required: Rush Charges Authorized? Phone Results Samples are: ANALYSIS REQUESTED <br /> ❑ Yes No m (Enter an'X'in the box below to indicate request; linter a'P'it Preservative added. <br /> (check if applicable) � q <br /> Special Instructions: (method, limit of detection, etc.) Drinking Water <br /> ❑ Collected in the 8 [� <br /> ' Explanation of Preservative: Slate of New York n <br /> AIR VOLUME E <br /> A <br /> CLIENT SAMPLE IDENTIFICATION DATE MATRIX/ Z �]v FOR LAB <br /> SAMPLED MEDIA (specify units) f� �C` USE ONLY <br /> ntoI <br /> -121 eltY) 4Drt ' <br /> - 03 <br /> I <br /> I - <br /> '` gad _2_-A yD <br /> O.� ,3 <br /> Relinquished by: Dater <br /> i CFIAW 0L7 Received by: DaleJime <br /> OF Relinquished by: 113at xna Received at Lab by: Datell 4 <br /> CUSTODY Method of Shipment: Sample Condition Upon Receipt: cceptable [] Other (explain) <br /> Authorized by: 49A <br /> &q�oDate <br /> (Client S natuio MustAccompany Request <br /> Please return completed for and samples to one of the Clayton Environmental Consultants Inc. labs listed below: <br /> 22345 Roethel Drive Raritan Censer400 Chastain Center Blvd., N.W. 1252 Quarry Lane WHITE - Clayton Laboratory <br /> Novi,Ml 48050 160 Fieldcrest Ave. Suite 490 Pleasanton,CA 94566 YELLOW Clayton Accounting <br /> (313)344-1770 Edison,NJ 09837 Kennesaw,GA 30144 (415)426-2600 PINK Client Copy <br /> (201)225-6040 (404)499-7500 6/90 <br />