Western Analytical Laboratory - Lead Sample Printable Submittal Form

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