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Billing Into r 'on Alpha*a1enue, <br /> tical, Inc, <br /> Name /f°- sy 255 G <br /> ten Suite 21 •�' r r <br /> Address e'—,i- Sparks,Nevada 89431-5778 Page# of AA - <br /> City,State Zip + -`?�-� f 1 1` !f!= Phone (775)355-1044 <br /> Phone Numbep,�I, ��% �'= `� FaFax (775)355-0406 Analyses Required <br /> Client Name PO # Job# <br /> Address <br /> PWS# DWR# � <br /> City State Zip Phone# Fax# 1 L� <br /> Time date rytw Office Use Sampley Repoottenhon Totalantltypeof <br /> ! ver' <br /> Sampled Sampled See Key <br /> Only containers /\ i�4 <br /> Below Lab ID Number Sample Description REMARKS <br /> I <br /> I <br /> ADDITIONAL INSTRUCTIONS <br /> Signature Print Name Company Date Time <br /> Relinquished�y t' " f of -2 <br /> q u7 f../✓.E'!`�'-rr t �3�fG I��.'e- ., � t--/.��+`� �t�/ � �j�, �'L} 4� 1"r C <br /> rrr r� I <br /> Received by <br /> Relinquished r <br /> �a <br /> Received by ` 51L) <br /> Relinquished by <br /> Received by <br /> "Key AQ-Aqueous SO-Sort 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 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 paid for the report <br />