Western Analytical Laboratory
Lead Sample Submittal Form
Please print and complete this form to include with your sample(s)

 

Name:

Address:

 

Property Address (if different from above):
Phone/Fax:
Email:

I would like to receive the initial results by: ____phone     ____fax     ____email
(Note: Hard copy of the report will be mailed to you in 2-3 business days)

 

Sample
No.

Sample Location
(e.g. living room, bathroom)

Sample Description

1.
   
2.
   
3.
   
4.
   
5.
   

Pricing: Lead Paint -- $50 for one sample, $40 for each additional sample.

Mail the Sample(s) to:

Western Analytical Lab
12734 Branford St, # 19
Arleta, CA 91331

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