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_ . <br /> 04. <br /> A611 <br /> _ <br /> ENVIRONMENTA! REQUEST EO�t LASORA ( o <br /> For Clayton Use Only page of <br /> 3 CONSULTANTS . ANALYTICAL SERVICES <br /> ProleclNo. <br /> ES <br /> A r+lanh 8 Mri�r+wew[os�n� Batch No, <br /> O Narne ipG Client No. 0 <br /> L TRIeDate Logged!n <br /> rNo. <br /> Purchase Oder By <br /> j mailing Address Dept. Client ab <br /> w Cdy.State;I1 Name <br /> Telephone No.ult w O Q ompany <br /> D e Results Talnfax No. rn z Address pe <br /> Charp� <br /> ® R�lllorixsd? Phone Results $am�fes are: Ch .State,Zi <br /> . T Yea . ®!.b <br /> 7nstruc ions:(method, old (check if applicable) c (Enter an'X'in the box below indicate regALYSIS Qest;En era'P'it Preservative a <br /> .otC.j <br /> �plt�ta4� Z ❑ Drinking Water ddod. <br /> Explanation Of Preservative: 'If D ❑C01k3ced In the <br /> Stale of New York <br /> t: <br /> CLIENT SAMPLE tDENTIFlCATtQN l DATE MATRIX/ AIA!'GLUME E <br /> �- SAMPLED MEDIA (specity units) Z �� FOR LAB <br /> �- 1` USE ONLY <br /> r <br /> z• r <br /> 1` <br /> CHAN ReianFrqutsrtd Dale rm <br /> PAnqumed by - Received by: Data/Time j <br /> CUSTOedy Date/ia»s Received at Lab <br /> til WNW of sh'10meni, Fupmann-vil.-E <br /> e/Time <br /> Authorized by: � Sample ConditioAcceptable ❑ Cnher(explain) <br /> 5 pl ) <br /> (Clienl Signatkire Must Accompany Request) Date <br /> Please return corn ted form and sem s Io orte of the Cla an Envirnnmenlal Consultants,Inc. Rd below: 1 <br /> 22345 Roetlta)Drive Rarkan Center <br /> 400 160 <br /> Novi.MI 491150. Chastain Center f31vd„N.W. 1252 Quarry Lane DISTAfBUTIDN: <br /> Fieldcrest Avvr. Suite 490 WHITE . Clayton Laboralory <br /> L313)344-1770 Edison,NJ 0837 Kennesaw,GA 30144 Pleasanton,CA 94566 <br /> ;201)225$040 4 5415)426-2600 YELLOW - Clayton Amounting <br /> ( 04)499-7500 6190 PINK - C6rd Copy , <br />