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Millis 0 �lpl alyoWIndy ��A V�NA � tttttttttf• l� <br /> Name t 255 GI a Avenue,Suite 21 ID OR OTHER rx�df <br /> Address r `�' SparkWada 89431-5778 <br /> p C,r��w �ro n .� � R� Phone 5)355-1044 <br /> City State,Z <br /> Phone Number Fax ��"� ��7[,—Gam Fax (775)355-0406 Analyses Required 06438 <br /> Client Name PO # Job# <br /> Required QC Lever <br /> Address EMail Address i I n ll! IV <br /> 1 , <br /> Gty Stat Zip Phone# Fax d �( <br /> EDD/EDF YES NO_ <br /> Time Date Matnx' Odice use sampled by Report Attention Total and type of Q— _" <br /> Sampled Sampled See Key Only Feld containers ! ��?► Grobarinr <br /> Below Lab ID Number Sample Description TAT Fdtemd See below REMARKS <br /> i yC — —5- <br /> 01-10 1JX AQ -M is — <br /> n--6 - <br /> 3 N I IN ti►_ - - 5 <br /> ` I 7f, Ilk` <br /> 9zs C — 5 <br /> Ak <br /> If Aa CPT- <br /> ADDITIONAL <br /> P -ADDITIONAL INSTRUCTIONS. <br /> SkgI <br /> nature Print Name Company Date Time <br /> Relinquished h P120 <br /> Received by <br /> Reknquished <br /> e <br /> tshed h <br /> Received by <br /> 'Key AQ-Aqueous SO-Soil WA-Waste OT-Other '" L-Liter V-Voa S-Sod Jar 0-Orbo T-Tedlar B-Brass P-Plastic OT-Other 1 <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 liability of the laboratory Is limited to the amount paid for the report <br />