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Name bining ir�tormatlon --IV 255 <br /> Analytical, Inc <br /> 255 Glendanue,Suite 21 Page# of <br /> Address res�c.rry Pn.c2cG_L)/L— Sparks,Ne 9431-5778 <br /> ,� ��u. e�� ,�t tG Phone (775)355 1044 <br /> C C.� L <br /> City,State,Zip L i Fax (775)355 0406 Analyses Required [ <br /> Phone NumbeW ��� ' Fax G x, ?:Sc <br /> ChapA.Hame PO # Job# S7� d�it <br /> c4c'le <br /> Address PWS# DWR p <br /> City State Phone# Fax# <br /> Time Date Nhtu* Office Use Sampled 6y { �L� Reportptlen� r Total and type of <br /> Sampled Sampled See I(eY y r`` f� containers QL rh r <br /> Below LablDNumber Sample Description "See below `1 ~ REMARKS <br /> -60 <br /> at:s� U <br /> CYR <br /> ADDITIONAL INSTRUCTIONS <br /> Signature Print Name Company Date Time ' <br /> e by .�..,. 2119 CW <br /> Re"y <br /> All /9L-PHA <br /> Relinquisheiiby <br /> Recerved b ` w _ <br /> y <br /> Relinquished by <br /> Received by <br /> i <br /> 'Key AQ-Aqueous SO-Sod 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 atter 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 />