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For Clayton lase Ony paw <br /> —01 <br /> ENVIRONMENTAL REQUEST FOR LABORATORY Protect No <br /> CONSULTANTS ANALYTICAL SERVICES SatchNo � <br /> A ANnh a"Iamm tong," Cunt No � <br /> Date Logged in By <br /> � <br /> r <br /> Name, E s t. TRS Purchase Order No Client 00 <br /> Cor� asftffiga <br /> De <br /> Matting Address pt o cu'i Narne <br /> eg <br /> Cay,State,Zip y Address D <br /> Tele*"NO ToWn Na z <br /> City State zip <br /> Rap Results TA- MI R®Yee u? Phan ResuUs S13 wearrPles are ANALYSIS REOUESTED <br /> (Check d appl y (Enter an'X'to the box below to indicate request,Enter a?I d Preservaira added <br /> Spemal lrsstwdrorrs (method,WN of"Kla%etc.) Drinkang Water c <br /> 7'U"4P.s9-.VZ) ❑Collected in the <br /> Expianairon o1 Preserimme r„eE State of New Yank <br /> CLIENT SAMPLE IDENTIFICATION DATE MATRIXI AIR VOLUME �P FOR LAB <br /> SAMPLED MEDIA (specify units) = USE ONLY <br /> W— <br /> •i id 38 <br /> —f H <br /> Oi'IAd11 Received by Da wTune <br /> OF Reingtrrdted <br /> Daterrum Received at Lab by --� DaI&Time <br /> CUSTODY ted fA Shipment Sample Condition Upon Acceplabte [] Other(expiam) <br /> Authorized by Date <br /> (CI'ierd Signature Akat Accompany Request) <br /> Please return corn led Norrn and samples to one of the Clayton Environmental Consultants.Inc Was listed below DISTRIBUTION <br /> 22345 Floeth®l 9nve Raritan Center 400 Chastain Center Blvd.N W 1252 Ouarry Lane WHITE Clayton Laboratory <br /> Novi,MI 48050 no Follilcresl Ave State 490 Pleasanton,CA 94566 YELLOW Clayton AccowvuV <br /> ;319)344 1770 Edison.XJ 00837 Kennesaw.GA 30144 (415)426.2600 6190 PINIK Client:copy <br /> (201)225$040 (404)499-7500 <br />