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Cyton <br /> ELoggedlq <br /> P.�EN REQUE VIRONl�1ENTAL ST FOR LABORATORY CONSULTANTS ANALYTICAL SERVICES4 Marrh 6 Mitennan Company r6y <br /> Mnc�o <br /> me �(, , <br /> Title Purchase Order No,mpaDe t- Client Job No r�C�, �.�,� <br /> o a W Name t <br /> o_ � Mailing Address <br /> u <br /> W City, State, Zip z 6 0 ompany <br /> De t <br /> w5 �- <br /> LL Telephone No. Y) z Address <br /> Telefax No. Cit , Stale, Z+ <br /> Date Results Required: Rush Charges Authorized? Phone Results Samples are:Yes ❑ No 0ANALYSIS REOUES TED <br /> ❑ <br /> ❑ (check it applicable) c (Enter an 'X'in the box below to indicate request; Enter a'P'iI Preserv3liv9 ddc!dd <br /> pecial Instructions: (method, limit of detection, etc.) <br /> ❑ Drinking Water �C} <br /> ❑ Collected in the 8 ' <br /> ' Explanation of Preservative: State of New York o �O� a <br /> CLIENT SAMPLE IDENTIFICATION DATE MATRIXI AIR VOLUME R B <br /> 0 FOR LAB <br /> SAMPLED MEDIA (specify units) z h�( USE ONLY WATT L <br /> I <br /> i <br /> CHAW Relinquished by: Date/T` <br /> a Received b <br /> S A y Date/Time <br /> OF Relinquished by: 10atei Time Received at Lab by: .� <br /> CUSTODY <br /> (lllalhod of Shipment: Dat <br /> Sample Condition Upon R eipt: ❑ Acceptable ❑ er ('explain)' <br /> Authorized by: Date - ID ?-jo,W- <br /> "- <br /> (Client ignalure Must Accompany Request) <br /> Pt6a5e return com letedlorm and samples to one of the Clayton Environmental Consultants, Inc. labs listed below: <br /> DISTRIBUTION: <br /> 22345 Roethel Drive Ranlan Center 400 Chastain Center Blvd., N.W. 1252 Quarry Lane <br /> Novi, Mf 48050 160 Fieldcrest Ave. Suite 490 WHITE - Clayton Laboratory <br /> Pleasanton, CA 94566 YELLOW Clayton Accounting <br /> (313)344-1770 Edison, NJ 08837 Kennesaw,GA 30144 (415)426-2600 PINK - Client Co <br /> (201)225-6040 (404)499.1500 Copy <br /> 6/90 <br />