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iiiiiiiiiiiiiiiiiiiiiiim <br /> Mme ` •�a' � t° I nl al <br /> �_rtv 3 r V% c, Y e EW—!MVA V A <br /> 255 Gle Avenue Suite 21 /p OR OTHER # of'� <br /> Address ��v�3bVwr tytj� Sparks, da 89431-5778 <br /> City State Zip r L L> Phone ( )355 1044 � <br /> �'4Fax ' Fax (775)355 0406 Analyses Required 0 Q 5 0 9 <br /> Phone Number �'�:�...�,.}�— +? R..11 11 <br /> Client Name PO # Job# T I <br /> C " Requwred QC Level <br /> Address10 Ss EMai#Address 1 II II/ IV <br /> City State Zip if Phone k Fax# <br /> (A EDD/EDF1 YES V/ NO <br /> Time Dale Matrix' Off ice Use Sampled by S Reporl Attention Total and type of .` � Q <br /> Only Global ID M <br /> Sampled Sampled See Key y Field containers � (/} <br /> Below Lab ID Number Sample Description TAT File ed "See below I—' REMARKS <br /> ! 41 1-25 A6 CIT;�- lI 17- S N 5-v ✓ � � <br /> 2� -o(0 <br /> ADDITIONAL INSTRUCTIONS <br /> Signat e Print Name Company Date Time <br /> Relinquished by * I t 30 <br /> r _ c 13 Q-04 <br /> Received by — 33 <br /> Rehnquished ib <br /> Received by TC <br /> n+ O <br /> Relinquished by <br /> Received by <br /> 'Key AQ Aqueous SO-Sol) WA Waste OT Other *' L-Liter V-Voa S Soil Jar O-Orbe 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 />