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rsttting intormarton: — Hipna #TlCall, mc.Name �� 255 Glendnue,Suite 21Page# of <br /> Address C �— } s :�— Sparks,Ne8431-5778 , <br /> City,State,Zip Phone (775)355.1044 ---1�( <br /> Phone Num •2 t{Fax Fax (775)355-0406 Analyses Required <br /> Client Name _ <br /> l � `� / P.Q.# Job# Iti%-3---• <br /> C)7' Ar — <br /> Address / PW5# DwR <br /> City, tate,Zip / Phone# Fax# � <br /> Time Date Matro* Office Use Sample )4� Report ention Total and type oi <br /> Sampled Samplod See Key Only L ' ` containers <br /> Below Lab 10 Number Sample Description "See below u} REMARKS <br /> 0112 <br /> ADDITIONAL INSTRUCTIONS: <br /> Signature Print Name Company Date Time <br /> R ed by ` 4: <br /> �G- �� rbc_ l/ �•'� % f �. �G.-:� <br /> S r by , — <br /> Received by <br /> Relinquished by <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-Plaslic OT-Ocher <br /> MOTE- 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 liabiAy of the laboratory is limited to the amount paid for the report. <br />