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Namee. (-4l (G MfJJ�td Hnaiyucal, Inc , <br /> Address � },J ,� 255 Glend nue,5ur1e 21 ✓ <br /> Sparks,NOW89431-5778 Page W of <br /> City State Ztp `7 G Q.� Phone {775}355 1044 <br /> Phone Number PaxG Fax (77,9),355-0406 Arlaly5es Required 370 <br /> r <br /> Client Nam - <br /> i--Z P O # Job k <br /> Atldess <br /> PWS# DWri# <br /> Lity Statg„Zi' _ 7-4--/— <br /> pine Date Matuc Office Use Sampled by ReporSAilen VC! v )`��iw <br /> Sampled Sampled SPeKef OnEy L�� °—�e —�,- Totalandtypeof 7�QC12�y <br /> Belotif Lab ID Number Sample Description .containers <br /> .gee below ff <br /> REMARKS <br /> ADDITIONAL INSTRUCTIONS <br /> I <br /> Signature Print Name <br /> uished _ Company tate Time <br /> _ �(5 / �/ <br /> Bleed ) <br /> 7S— <br /> Pill <br /> R-,F en'ed h„ <br /> RQllntaulshed by - <br /> rtc�uived by <br /> }fey AQ Aqueous SO Soil WA Waste OT-Other <br /> NOTE Samples are discarded 60 days after results are reported unless other arrangements are madeer Hazardous osamples 5wlll be returned to li nt or dposed of t client expense <br /> OT Other <br /> ,,I the above sampes 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 p he report for the analysts <br />