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Name t.''� �`- f AIP naiy#ical Inc SeMP1e8 Collected From Which St ' <br /> ,+ c. K .w a.� l AZ_ CA,� NV_ WA <br /> Address 3 G�+titer e 5�a 255 ale Avenue Suite 21 W OR` OTHER Page _of <br /> P� �` 4`rD Sparks, evada 89431-5778 <br /> City,State,�Cc,c G,.� pr„Cl C,� q Sc g Z Phone (775)355-1044 <br /> Phone NumberZ3047[-Ceti;f Fax U0 Fax (775)355-0406 ArlalyseS Required F'� 1 n <br /> Client Name Q 6 U ./ <br /> C.z S f� �� PO # Job# r <br /> Address EMadAddress .2a"7'Do ca=01 1r Required OC Lever <br /> City State Zip <br /> L i � Phone# Fax# d 1 If 111 IV <br /> + <br /> �6r <br /> Time Date Matnx Office Use Sa led by., y�poctAnenUan "7 EDD/EDP?YES gyp <br /> Sampled Sampled See Key Only f'o�,�h C� a k,r r �o..z 7'� Total arrd type of k� <br /> Below Lab ID Number Sample Description TAT sero containers �e Gfobet ID ar <br /> �z/ Ane,ad ' See below <br /> It t o OT �.� r REMARKS <br /> 1120 iT X x <br /> UZ T�f C .57-47- <br /> 113U 2A0 E44' <br /> I <br /> ADDITIONAL INSTRUCTIONS: <br /> S+gnat Print!Name <br /> Relinq ed b / Company Date Time <br /> RTime <br /> ecervedb Lct t cST��lc�� t'•cur.o....te� lti "Z/7/mil ` Z <br /> Relinquished by '7 r <br /> Recewed by <br /> Relinquished by <br /> Received by <br /> 'Key AQ Aqueous SO Sal WA-Waste OT-Other L-Liter V Voa S-Sal Jar O-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 analysts <br /> of the above samples Is applicable only to those samples received by Etre laboratory with this coc The liability of the laboratory is limited to the amount n„m f,,, <br />