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S <br /> � 1•I <br /> Ciayton <br /> RN <br /> Use Only Papr�?IENVIRJNl�4ENTA R QU ST AOR LABORATORY CQNSULTANTS ANALYTICAL SERVICES A?44rsh aAtrtennanOrder Na, edClient Jots No. Op d InName , ' OMama �u--- �� Thte <br /> w O r, Company Q �{ L -rn Company <br /> a 2 Addrta Dept. aMaihp Ad da! <br /> r�es>s? < <br /> C:hlf.Suite,T.i Lu Cary,Slate,Zip - <br /> Qate Aesur Required ¢ s <br /> ��p Aush Charges C.uthartzed7 Telephone No, o <br /> a RAY / • 'T.� Tetefu?i <br /> Spfolal lrstruetlons: (rtiethod,limN of dt est3on,phone resutta,wish results,e }ei O Ho ANALYSIS AEOUESTED t <br /> (Enter an X in the bar below to tndluie rrgvest;Eater a P 1f F}r,rn rJra <br /> •Erplanatfon of prey rativsi weeRNA?z t1s1j� ��yjF o e <br /> aa— {� <br /> ' ` <br /> Dctef �rnc 8 O z c , <br /> CLIENT SAMPLElDENTIFICATlpN DATE MATRIX/ AIR1rOlUME <br /> / SAMPL=Q IMFDIA (spKifyunhs) <br /> FOR LAB <br /> .Q'? — u USE ONLY <br /> ` c <br /> .1 <br /> _t <br /> CHAIN Arl1n ulshei b ; <br /> OF Da:r.Timc <br /> CUSTODY Relln r;zhrJ b L^ Reeeived b ti <br /> Dale 71ma - - flare!-time <br /> . (lf re-rsalre-H1 Rrceivrd of lab b : - u^. <br /> Irrthod of Slipmertt: Sample COnvr:ton u;�g'receipl <br /> D.1- "n <br /> - (Client SIEIna:urc Rust Accompany R uc%I Date - ""�•� �., 1) / LV <br /> -q ) <br /> Pleases return coMi letcd farm and samples Io one of the CI■ on Envlronmmtai Consuhanls,fns,tabs lisle below; .i <br /> x23:5 Fioethet Dtlrt Raritan[enter DISTRIBUTION: <br /> t <br /> Novi,MI 48050 [DO Chastain Cenler Blvd.,N.W, ry ane <br /> 167 Fiefdctest Ave, Su11e 190 1757 OuarLWHITE - Claylon Laboratory- <br /> (313)344-1:77o FJ!son,NJ 06637 Kennesaw,CA 30144 i lsasanroq oo 9A 566 <br /> (zot)az�6o40; (4w)499-7500 l4t s}azs zsan YELLOW - Clzylon Accounting <br /> PINK Client Fietalns <br />