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Samples Collet ed From Which State" • <br /> Ulm!] Infoattan 1 Alpha AAT Inc Az CA NV WA <br /> Name _ �r�}v5 v►ran.,sanr n6 L, 255 Glendale Avenue Suite 21 ID OR OTHER Page# I of <br /> Address 333D P ()c „��o. S� Sparks Nevada 89431 5778 <br /> 4& Phone (775)355 1044 Analyses Required City State Zip ��enst er P r k C. t,Sz. Fax {775)355 0406 Y 4 ed 65O9 <br /> Phone Number[S Ji)t, .b- CCAu Fax (e r.\0(t--(QDS <br /> Client Name PO M Job <br /> 115 03 <br /> — Required QG Leve! <br /> Address Email Address <br /> V <br /> City State Zi Ph ne# Fax N k <br /> EDD/EDF7 YES N4 <br /> Time Date MatrW Office Use Sampl d by Report Atlen on Total and type of ` ny 1 srata.r ID <br /> Sampled Sampled Key Only ti ' F. d containers <br /> Below Lab ID Number Sample Descnption TAT FArered See below REMARKS <br /> y 1� aZ <br /> Ill +o I�S N a I _ <br /> ►S ��� <br /> 014 _ <br /> )5 C FT 22 <br /> ADDITIONAL INSTRUCTIONS <br /> S gnature Print Name Company Date Time <br /> Relinquished by r� t� <br /> Received by RH CA <br /> Relinquished <br /> Received by A S O 2 .114 <br /> Relinquished by • ` S <br /> Received by <br /> 'Key AO-Aqueous SO-Soil WA-Waste OT-Other L-Liter V-Voa S-Soil Jar 0-Orbo T-Tedlar B-Brass P-Plasbc OT-Other <br /> NOTE Samples are discarded 60 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 analysis <br /> of the above samples is applicable only to those samples received by the laboratory with this coc The Itabdity of the laboratory is limited to the amount paid for the report <br />