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BULK SAMPLE: Request for Lead (AA) Analysis

• Select a leakproof container such as a Ziploc sandwich bag.
• Carefully place the sample in the container and seal.
• Number each sample
• fill out log sheet
• enclose check for US $35 per sample
• mail

Sample No.	Type Material	Location/Description	Amount
1			$
2			$
3			$
4			$
Total:			$

Note 1: ONE sample per baggie, place sample NUMBER on each bag.

Your Return Address (Address to send laboratory results)										

					

						
						
						

							
							
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