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BifIjn9)q!0rWWn., 731e(nd <br /> tical, Inc. <br /> Name r':r �ra� nue,Suite 21Address r✓ a.r c�c 89431-5778 Page# L of <br /> City,State,Zip .r: rt [ 5-1444hone Number �� •"ki IE Pax Cf 1( G��v 0406 Analyses Required 1 <br /> Client Name <br /> Address 0770 <br /> Phone <br /> � <br /> PVVS# DWR# ;A <br /> City,State,Zip /% • Phone# Fax# " ) <br /> Time fate Office Use Sampled by Report Attention - V 4u <br /> T4t <br /> Sampled Sampled See Key only "' '" � � containerseof <br /> Sampp <br /> Below Lab ID Number le descrition "Seettelow REMARKS <br /> `_r/ <br /> 3 MW -3 ,✓ <br /> Mk__ / SC <br /> 7 W-25 v <br /> �y�✓ / <br /> �'V Z f U 1 <br /> d yam- <br /> ADDITIONAL INSTRUCTIONS: <br /> Sign Print Name Company Date Time <br /> Relinquished L ��� •Z 4� Z Z <br /> Recei <br /> %jinquishe y <br /> •Z�7i ��D <br /> I <br /> R ved by` <br /> �Y� Q_ <br /> Relinquished by �J <br /> Received by <br /> *Key: AQ-Aqueous SO-Soil WA-Waste OT-Other ": L-Liter V-Voa S•Soil Jar O-Orbo T-Tedlar B-Brass P-Plastic OT-Other <br /> f 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 liability of the laboratory is limited to the amount paid for the report. <br />