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rsl►iing tntorlr tojn Alp tical, Inc <br /> Name �i"' T.Iv 4�' �cs�'J �1v,ILsD'ln�t 255 Gland anus,Suite 21 I <br /> 9 <br /> Address oil r� Sparks Nevada 89431 Page# of <br /> City,State,Zip Ct. f Phone (702)355-1044 <br /> PChentNahone Number s? ^ Fax _5 a h Fax (702)355-0406 Analyses Required <br /> ML <br /> ,e lia j� <br /> i ✓,5 P-fes 4ZA-4 PO It Job�QO� <br /> Address <br /> PWS u , <br /> own <br /> City,Stale,Zfpti !' <br /> Phone# Fax <br /> Time Date MaW' Office Use Sampled by <br /> �R,portAtlenbanr-� � <br /> See Ke only {tv , , t'� �a �y� Totalantl€ypeof 9 D1 <br /> Sampled Sampled y ooandlers <br /> Below 1_ab ID Number Sample Descnplior� " ee belowatainers <br /> REMARKS <br /> f <br /> � - �� Pas - 15 - tt� r <br /> ADDITIONAL INSTRUCTIONS <br /> Signature Print Name <br /> LRO:nqu�i3hed Company Date Time <br /> Received bj, Ey, �— , yr C �3-� C- S <br /> '�Y�V1,G�gM.I1 �� � <br /> ze <br /> Reline�uishatt r r ti y Via.L ,�4 5 7.L {Jp cJ•Zo <br /> Received by <br /> Rehnginshad 6y <br /> Received by <br /> `Key AQ Aqueous SO-Soil WA Waste OT-Other '" L Liter V-Voa S Soil 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 ciient 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 renert <br />