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. tonly Lot i For Claytari Use Only ?490w-� <br /> ENVIRONMENTAL REQUEST F0 LABORATORY ProlectNo !jf;j.2:.''79 <br /> CONSULTANTS ANALYTICAL SERVICES Batch No <br /> Ind Code p "4 <br /> Date L ed Itt B R <br /> Nm"e7'� Title Purchase order No Client Job No <br /> camp-any n Dept W Namei2LeA �- <br /> a <br /> -r Marlin Address Company pa <br /> pt <br /> C State.2 Z Address <br /> o <br /> T s ft T*Wax No - lCity.State, Zip Z:iw <br /> 0 <br /> Dale Flesulte Req I Rush Charges zed? ane/Farsults SaRples ale ANAL YS IIESTED a <br /> 7- E3 Y88 (3 No 17 C3 (check d applicable) <br /> (Enter an'X'to the bort below to indicate r uest;Er*r a P 11 preservative 0 <br /> pedal Instruchons (method. limit of detection, etc.) [I Dnnku4}Water <br /> Y TA r 13 Collected in the <br /> Explanation of preservatae 3 t ftL a,e l' k+ � State of New York ,�♦ ~' <br /> w .2 ca <br /> �Q �Q <br /> CLIENT SAMPLE IDENTIFICATION MATRIX/ AIR VOLU ME E FICATiON #f F sec unitsSA <br /> Fa <br /> W% W <br /> 1 � <br /> 71 <br /> f - <br /> - <br /> rb' <br /> �n <br /> 0 <br /> 1 <br /> Collected by. '�y)I (print) Collector's Signature <br /> CHAIN Relinquished by Date�me VIAP <br /> OF r Received by DatelTtme <br /> CUSTODY Relinqurshad by ate/Time Received at Lab by Date/Time <br /> Method of Shipment Sample Conditm upon f eta Acceptable Q her (ert al <br /> Authorized by. pate � <br /> (Client Signature Must Ac=pany Request) <br /> Please return ovm sled torn and sa les so one of the Clavion Envwonmental Consultants Inc labs fisted below <br /> 22345 Roelhel Drive Rantan Center 400 Chastain Center Blvd,N W 1252 quarry Lane DISTRIBUTION. � <br /> Novi, M148375 160 Fieldorest Ave Suite 490 Pleasanton, CA 94588 WitITE - Ctraytorttgbcl <br /> (8100 344-1770 Edison,N.!08937 Kennesaw, QA 30144 (510)426-2657 YELI OW - Clayton Aox <br /> (908)225-6040 (404)499 7600 PINK Chant Retains <br />