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� I <br /> E3111tng information Aipna Wlytical, Inc <br /> Name C�-.LxV 255 Glenvenue,Suite 21 F <br /> Address 33 -- � �'�rt�lCfor, Sparks,NOMa 89431-5778 Page# of � <br /> City,State i Phone (775)355 1044 <br /> Phone N G 4 Fax Fax (7'75)355-0406 Analyses Required , <br /> Client Na�men L` Job# <br /> PO # <br /> Address Z�Z'.57- 20 p— p/ <br /> PWS# DWA# <br /> City State,Zip <br /> C PFax#hone# ({\tj <br /> �L C� Li �} I <br /> Time Date MatM' Office Use Sampied ReportAttentio �C k <br /> On' �e� Total and e of <br /> Sampled Sampled See Ke Y 1Yp <br /> uJ { <br /> Y Prr,2,� <br /> Below Lab 1D Number Sample Description •mse�lbeknv <br /> f REWARKS <br /> d5 <br /> /14k/ <br /> r!0, <br /> /VU4 <br /> IIA- Mw 7 <br /> 10 la h Mw -� <br /> a--n <br /> eco <br /> I <br /> ADDITIONAL INSTRUCTIONS <br /> SigneAture Pant Name <br /> R u edb Company Date Time <br /> R ei a by . I-i // 09 4a <br /> Relinquished by 1 [ r -2 (.{ <br /> eke e by <br /> Relinquished by <br /> I Received by <br /> 'Key AQ-Aqueous SO-Soil WA-Waste OT-Other •' L-Liter V-Voa S-Soil Jar 0 Orbo T-Tedlar B-Brass P-Plastic OT Other <br /> NOTE Samples are discarded BO days after results are reported unless other arrangements are made Hazardous samples will be returned to client or disposed of at client expense The report for the analysts <br /> of the above samples is applicable only to those samples received by the laboratory with this coc The liability of the laboratory is limited to the amount paid for the report <br /> f <br />