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• <br /> Cayton For Cla f'a-Ura 0-1 <br /> ENVIRONMENTAL REQUEST FOR LABORATORY P aject Na 3 LI SDG, o u <br /> CONSULTANTS ANALYTICAL SERVICES Batch No <br /> A Marsh 6 McLennan Company Client NO <br /> date Logged in S By <br /> Name /�,�f s r J,r'r' Title P.�reha�e Order No Client Job No <br /> Company Q a'o Dept o U Name /j-✓ <br /> Mailing Addressp p mpany Dept <br /> City,State,Zip W z Address <br /> Telephone No Telefax No — Uly Siate Z <br /> Dato ResultsA,L Required Rush Charges Authonzed1 Phone Results Samples are ANALYSIS REQUESTED <br /> w ,p` <br /> [[33 Yes No ❑ m (Enter an X in the bon be off to Fnd cava req jes' Enter a P it Praseroatwe added <br /> (check t#applicable) <br /> Special Instructions (method,Itmtt of detection,etc) ❑ Drinking Water <br /> opt t�r(L 2 W AG Tkie t.Fl}-,Q.�k•/� ❑Coltected in the <br /> Explanation of Freservative State of Now York <br /> CLIENT SAMPLE IDENTIFICATION <br /> PATE MATRIYJ I AIR VOLUME E �P✓ v�v y FOR LAB <br /> SAMPLED MEDIA (speci#y units) z' C(/ �� r USE ONLY <br /> FLEE <br /> ff <br /> t � <br /> i <br /> —2. -a <br /> -3 WK <br /> �A <br /> *r e-T fX. <br /> Ar <br /> { _ F <br /> 5— MEL LID <br /> I Da e1TDate!#ime <br /> Relinquished by _ 3�0 Received by <br /> CHAOF Relinquished by Date�ma Received at Lab by Dat <br /> 11 LOS 14 <br /> CUSTODY Method of Shipment Sample Condition Upon Receipt Acceptable [3Other (explain) <br /> x <br /> Authorized by Data 'r —s <br /> (Client Stgnattr(e Must Accompany Request) <br /> Please return Com leted form and samples to one of the Clayton Environmental Consultants Inc labs listed below DISTRiBUTIQN <br /> 22345 Roethel Drive Raritan Carter 400 Chastain Center Blvd N W 1252 Quarry Lane WRITE Clayton Laboratory <br /> Novi,MI 48050 160 Fieldcrest Ave Suite 490 Pleasanton CA 94566 YELLOW Clayton Accounting <br /> (313)3441770 Edison,N,# 08637 Kennesaw,GA 30144 (415)426 2600 6/90 PINK Client Copy <br /> (201)225 6040 (404)499 7500 <br />