Laserfiche WebLink
Mtti,n-rmtM I M I♦ IWIph�alyJlW Ind N V MEIVA w <br /> Name , ✓ D 255 GI Avenue Suite 21 ID OR OTHER <br /> Address n�t�nn A r to �i�sC�i Sparks da Fl9A31 5779 <br /> —� ���y 7 Phone 5)355 1044 <br /> City State zip C mzron V.-r-14 •.. *� <br /> Phone Number Fax �� ���i- CSS Fax (775}355-040& Analyses Required / <br /> Client Name PO # Job# <br /> Required CC Lever <br /> Address EMasl Address <br /> 1 11 111 IV <br /> City State Zip , Phone# Fax# k <br /> a CA <br /> -� EDD/EDF YES NO <br /> Time tate Matrix' Office Use Sample by a ReporlAttention Total and type of <br /> See KeyOnly containers '� MOW 40 r <br /> Sampfed Sampled Field <br /> Below Lab Ip Number Sample Description TAT Filleted "See below REMARKS <br /> 7 cxx STfuorm C CT— 1 -- — 1 <br /> C PT- ) Q - 1--2- v I I <br /> j <br /> h <br /> ADDITIONAL. INSTRUCTIONS <br /> ignatu Print Name Company Date Time <br /> Relinquished b <br /> Received by r - } <br /> Relinquished f <br /> ]2�shed <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 <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 />