Analytical Lab: Client Information Form
Please send Client information form and samples to:
ERI Consulting, Inc. Office Use Only
Att: Analytical Lab Client No. _________________________
2026 Republic Drive Suite A A.S. No. __________________________
Tyler, TX 75701 E.S. No. __________________________
Date Needed: _______________ 2 days; 3-5 days; week; expediated service is extra charge.
Name: _______________________________________________________
Address: _______________________________________________________
Location: _______________________________________________________
Phone: __________________
Fax:
 __________________________
Relinquished By: _______________________________________________________
Contact/Report To: _______________________________________________________
Returned: __________________
Archive:
 __________________________
Invoice To: _______________________________________________________
Sample Date: __________________
Lab Date:
 __________________________
Analyst Date: __________________
Q.C Date:
 __________________________
Preliminary Report To: _______________________________________________________
 
Samples:  
Client No. __________________
A.S. No.
 __________________________
 
Comments/Special Instructions:_______________________________________________
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