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Billing InformationSamples Collected From Which Staten <br /> Ak�halytical, Inc. AZ CA� NV_ WA <br /> Name 's ws v. '��- 255 GIs venue,Suite 21 tp OR_ OTHER Pa e# of <br /> Address w k d Sa Sparks Nevada 89431 5778 <br /> City State,Zip .K W.'" Par A, � G4 Phone (775)355 1444 [[�� [[ �7 <br /> 54 <br /> Phone Numbedfsc-G W.-Goa Fax Sia-�1F-Go0s Fax (775)355 0406 Analyses Required t.f J I <br /> Ghent Name Pp M job# <br /> „T ..eJ 12 Z3 Required QC Level <br /> Address EMail Address ! 1! !!! !V <br /> /S-4, cc f 1 r'l�.r ��i <br /> Csty State Zip Phone# Fax# <br /> UEDD/EDF YL NO_ <br /> Time Date Matrix' Office use Sampled by aepgn Attenton Total and type of q 'r d m <br /> Sampled Sampled See Key Only n e w r r F,e,d containers ° 4 Global rD s <br /> Below Lab ID Number Sample Description TAT Ferered See below �- �- W w REMARKS - <br /> f t 3. e1%412-co AQ 13�Lc (� c�t Al h/ -, 1 9,v X Xx <br /> o it-o zsa ,K ry z, <br /> t t o is t 2.41- -D3 M vr/— <br /> Its mbiL- MA <br /> 12,10Y LS-0— Alw <br /> 3Lo z A4 W <br /> to LCL M W r ! <br /> 67JB M Ly ip -- 1 <br /> 0q45 i.aa —Cyl itrr WO .2, <br /> oS za z "71D /N wo 3 <br /> o a Ma—, <br /> R —1 I ryrw a - 1 Sid f. Y X X X <br /> F771 I I <br /> ADDITIONAL INSTRUCTIONS <br /> Signature Print Name Company Date Time <br /> Relinquished by � - l �� <br /> iNCS.r a u Q .,L j �y41 /!C !1 -Lts'J t .Z 3 <br /> Received by Gr r-at(fja{'J <br /> 0't ALSO <br /> Relinquished by <br /> Received by <br /> Relinquished by <br /> Received by <br /> 'Key AQ Aqueous SO-Soif WA-Waste OT-Other " L-Liter V-Voa S-Sail Jar 0-Orbo T-Tedlar l3-Srasg 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 Haid for tha rannrt <br />