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SilverState 3638 E. Sunset Rd., Ste. 100, Las Vegas NV 89120 CHAIN -OF -CUSTODY RECORD <br />Phone: (702) 873-4478 Fax: (702) 873-7967 <br />j Analytical Laboratories p 4587 Longley Lane, No. 2, Reno, NV 89502 <br />www.ssalabs.com Phone: (775) 825-1127 Fax: (775) 825-1167 Page of <br />ProjectfJob #. <br />Payment MetheMO #: <br />Q <br />Name: <br />p <br />f <br />Name:/ r <br />lit- G <br />Company: �� /•..+ 1 G>/�i �/� /jvL� <br />—\ <br />���jjj U <br />\ <br />�j <br />(lam- <br />Company. <br />Mailing Address: <br />✓C� �J <br />Ma➢InflAddresa: Z�o 70o <br />Ja. <br />city, state. Zip; <br />�� <br />1 2 Day <br />OFQ- <br />Other <br />W" <br />City, Slate, Zlp: <br />`Y <br />Phone: O f �o/_(07/� Fax Finalh. ,�{{ O�%�l <br />Sampled By: <br />G6k x�?i-,n­ <br />Turnaround Time (Specify Below with an X): <br />Standard 10 Business Days <br />© <br />Other Pertinent Info: <br />E <br />z <br />_ <br />ANALYSES REQUESTED <br />Circle Applicable Program: <br />SDWA OWA RCM Other Non -Reg <br />Reporting requirements: <br />RL MDL POL <br />Report Level: <br />1 II III IV <br />NOTE: 9uau yr �ppf/bLM11��M Nwyne <br />Report A lierilbn: <br />—\ <br />���jjj U <br />\ <br />�j <br />(lam- <br />7 Day <br />1 2 Day <br />3 Day <br />Other <br />On -Site pHlrempornture: <br />NOTE: A surcharge Is applied for rush samples <br />Dale <br />Sampled <br />Time <br />Sampled <br />Sample Location/ Silver Slate Comp/ <br />Sample ID Lab ID Grab <br />Matrix• Preservative <br />-,4 <br />'Metals: <br />NT vE - <br />X <br />X <br />X <br />7/b <br />- <br />lU vE 7A/Z <br />Tampering Win sample name, date, time, and location may consdtute fraud /� •�� <br />Relinquished t, <br />SI nature/Print: TlmdOata: ' � s <br />Relinquished by <br />SI nalure/Print: Tlnte lDate: I <br />Received by / <br />S nalum/P n • G/ �_ <br />Received by <br />5 nature/Print: <br />�o2r73 <br />Tlmo/Date• <br />Time/Date: <br />Authorized n Is r Date: <br />Authorization u requYed la prooaa samples. Thla obillwas your apenizatlon for too pertaining to services rendered. If collections or loped services we <br />required to recoverseld feet, your orpanizrllon wyl be respondble Wait Ism and Dolt in eddrJon to eervi-fam. - <br />Method of Delivery: Receiving Laboratory: <br />Special Insuuc one:.�CI%%7p�G /d ��% X. <br />J <br />Note: Sam lss are dk dod 30 day, s11er resuhs ars re orted. Sem s deemed hazardous are returned b are client u on Dom letbn of anal Is. <br />Key: AQ — Aqueous S — Soil W — Waste OT—Other — Key: P — Plastic G — Glass V — VOA Vial OT -Other <br />