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i <br /> Sillin p m Banc Alp#le <br /> nalytical, Inc. / <br /> NameV 255 Avenue,Suite 21 page tt of—LAD }� Sparvada 89431-5778 <br /> Address Phone (775)355-1044 A <br /> City,State,Zip G 1 Fax (775).f55-0406 Analyses Required <br /> Phone Number 6 L Fax <br /> Cliant Name <br /> Address PWS ft DWR <br /> City,State,Zip Phone fk Fax 9 '� <br /> 1�31tCc' Office Use Sampledby t/.` I ReportAltenlion Tolalandtypeof <br /> Time Dale <br /> See Key Only Containers ' <br /> Sampled Sampled REMARKS <br /> Below Lab 10 Number Sample Description .,Sea below <br /> YA <br /> ADDITIONAL INSTRUCTIONS: <br /> Si r' Print Name Company /Dale JJ Time <br /> rielinq ' ed-bye' �J �'�- v5 <br /> en. <br /> �� <br /> Re b . 7f <br /> Relinquished 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 O-Orbo T-Tedlar Q-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 />