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^ l ,► lota [13atch <br /> or Gsa}hon Use 7171page_ of <br /> FNVIRdNMENTA! REQUEST FOR LABORATORY ro,eclNo <br /> CONSULTANTS ANALYTICAL SERVICES NoA ALtah i Akltrow[wapimy hant No <br /> 0ate Logged In 15l H <br /> Name Tula Purchase Order No Client Job Na <br /> t— <br /> company O Dept u Name � <br /> Mailing Address z�? pany D <br /> W <br /> COY-State,ZIP Address <br /> Tekowrte I o I Tolefex No UO—V State Zip <br /> D Resu05 ire Mush Charges Auftn=d Phone Results Samples area ANALYSIS REQUESTED <br /> (3 Y" [3 No (chsdl applrc2ble3 1 (Enter an X in the bo below to indicate request,Enter a P it Preservative added <br /> rat Instructions (method,hms og dowan,oft) 0 Dnnkmg Waver E <br /> A109A4-A. X mP6Gst. -r&exq 4e-oL4A(' ❑collected in the Q , <br /> ' Explanatlron of Preservative P!S Iia, Stale of New Yore 5 <br /> CLIENT SAMPLE IDENTF1CATiON DATE MATRIX/ AIR VOLUME E Q" ���\ FOREAB <br /> SAMPLED MEDIA (specrty units) z USE ONLY <br /> w — <br /> AO— - 46 <br /> lk Lo -z A <br /> _3 #0,kL <br /> { <br /> oil <br /> o a.a v <br /> RaMnqurshed fv DalefTune Received by Date/T'me <br /> COF Rollin#ursh�by DalefTrme Received at Lab by Date/T <br /> CUSTODY Method of Shipment Sample Condition Upon Receipt Acceptable 0 Ohe (explain) <br /> Aulhorized by Date s' <br /> ICNanI Signature Flus!Accompany Raquas!} <br /> Pludso ralurn com lelad IDrrn and sant las 10 una u!this Cid art f nvourm,t nrar Consult lints Inc labs listed below DISTRIBUTION <br /> 22345 Roelhel I)rrva Raritan Center 400 Ghaslain Genler Blvd NW 1252 Quarry lane WHITE Clayton Laboratory <br /> YELLOW Clayton Accounting <br /> Novi M1 48050 <br /> 16o Freldcresl Ave Suite 490 Pleasanton CA 94566 <br /> Edison M 08837 Kennesaw GA 30144 (415)426 2500 PINK Cheri Copy <br /> (313)344 1770 404 499 7500 6190 <br /> (2013 2zs 604o I 1 <br />