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d <br /> 0ayton For Clayton Use OnrY Pape d <br /> Proyecl No <br /> ENVIRONMENTAL REQUEST FOR LABORATORY Balch No <br /> CONSULTANTS ANALYTICAL SERVICES Cl en No <br /> A atan;h 6 Adrlenran Cownpany Dale Rccerved By s <br /> Dase togged In 13Y fi <br /> Purclare Order No Chent Job No Z s3 00 O Name Y �.3 5 Thle <br /> Nerve <br /> wo p [ampa^Y D -m( L ) Dept a-0 Mailing Address <br /> a Z A9drexa ¢� Crly State Trp <br /> C State Ti T_Ie hone No Teietu No <br /> Date Aesufs Required Aush Charges AuthodledZ ANALYSIS AEOUESTED <br /> a DAY 'r'A.T, Yes Q No (Ender an X in the box below to Indicate retruesl,Enter a'P r PreservzOvs addad7 <br /> Speetal Irstructions (method,limit of deteclron,phone resuha,rush tesahs,etc) e <br /> `o. <br /> o n <br /> Erplarralloo of Preservative E c Q <br /> �fif �CUP— 0 - C.�.Qir.'}Ps-,-,XD 0 z \ I <br /> CLIENT SAMPLE IDEtfTIHDATE MATRIXI AIR GLUME GATIOH \� �Q FOALAB <br /> SAMPLED MEDIA (specrpy units) USE ONLY <br /> 61- S2YJ2 <br /> } <br /> Relln ursl+rdb Da eTme �- Recervedb QsteTn+e <br /> OF <br /> CUSTODY Aelln ursre-d bX DalerTlme Rrcelvrd at lab b _ t}aie rme '2r)A v <br /> {lf re<,,IrrCl w"Isod o_f SLupnerrf Semple condrtron un poreccrptL1 <br /> Dates?LSG_ 11J�0 <br /> (Client S.gna'ure Mus?Accompany R quesl) <br /> Plesie rol,,rn eonp,tlyd torr-r and sunpres to one of the Clalion Environmer al Consuharis Inc labs liste-d below DISTRIBUTION <br /> 423-5 Farthel Drive safrlarr Center &DO Chastsm Cenler Blvd,N W 1252 Ouarry Lane WHITE - Claylon Laboratory <br /> Novi W 48050 160 F-rldcresl Ave Serle 490 Pleasanton CA 94566 YELLOW - Clayton Accounting <br /> (31))3A4 ST70 Edson NJ 0983? Kennruw,GAS0144 1415)426r2600 PINK _ Client Retains <br /> (201)22-UX0 (A 04)499.7500 <br />