Laserfiche WebLink
r <br /> tI I <br /> Cdayton For Cra{on Use Ory �a <br /> ENVIRONMENTAL REQUEST FOR LABORATORY Project Na. 3 �15GD, UU <br /> 'k CONSULTANTS ANALYTICAL SERVICES Batch No. (�[ <br /> am <br /> A Marsh&Mrtennan Company Client N0. <br /> Date Logged In s By <br /> i O Name /Gf� /j,V;r� Title Purchase Order No. { <br /> Client Jeb No. <br /> Company Dept, w Name <br /> a Mailing Address VA- <br /> o U om an s� <br /> W City,State,Zip w C1 O P Y - De t. <br /> Telephone No. .n z Address <br /> P Teletax No. Cit . State, Zi <br /> D,,at��Results Required; Rush Charges Authorized? Phone Results Samples are: ) <br /> 'r�¢!, ® Yes tJo (] ANALYSIS REQUESTED <br /> (check if applicable) (Enter an'X'in the box be;ow to indica!a request;Enter a'P'it Preservative added. 'i t <br /> Special Instructions:(method, limit of detection, etc.) <br /> ❑ Drinking Water �S .. <br /> f Collected in the c� -Q Jr <br /> Explanation of Preservative: State of New York �^ j <br /> t`1 <br /> i CLIi=NT.SAMPLE IDENTIFICATION DATE MATRIX! AIR VOLUME Q �, c 1 , F <br /> SAMPLED MEDIA (specify units) z S(/� t�2 r? USE ON6 <br /> �. . , <br /> 1 <br /> 14 <br /> -3 A-7- S <br /> Ar ter- t <br /> `r ... <br /> :�- _.. .... __.. _-. Relinquished.by'Z--- _.._.._. __.. � -- . .... Da em _.. _. ._ ... _..... . .. .__ la <br /> CHAIN _ _ �0 Received bp: Date�me <br /> OF Ralin uished b : t7ateTme <br /> q Y Received at Lab by: Dat <br /> CUSTODY30 <br /> Method of Shipment: Sample Condition Upon Receipt: Acceptable [3 Other(explain) . <br /> Authorized by: - Date <br /> (Client Signatt:re Must Accompany Request) <br /> Please return completed font and sam les to one of the Clayton Environmental Consultants, Inc.labs listed below: <br /> DISTRIBUTION: <br /> 22345 Roethel Drive Raritan Center: 400 Chastain Center Btvd.,N.W. 1252 Quarry Lane WHITE Clayton Laboratoryt <br /> Novi,MI 48050 160 Fieldcrest Ave. Suite 490 Pleasanton,CA 94566 YELLOW - Clayton Accounting <br /> (313)344.1770 Edison,NJ 08837 Kennesaw,GA 30144 (415)426.2600 <br /> PINK Client Copy <br /> (201)225-6040 (444)499-7500 6/9a <br /> 4 _ _ - <br />