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Billing Informatt Y, Samples Collected from Which Sta <br /> ,�°' Alph�avenue 1, frac AZ CA� NV_ WA <br /> Name � ?�� ��oK � a.�. !� 255 GI a Avenue Suite 21 <br /> Address 33G��G.a.a ex 1171 S4.c{o 5S'c7 Sparks,Nevada 89431-5778 1D OA— OTHER Page J_of <br /> City State Zip --e--LeepK Pte. � C._ 4 S4 S' Z Phone (775)355-1044 <br /> Phone Number o 4 9-4cwt Fax XL30 974-600-" Fax (775)355-0406 Analyses Required 06012 <br /> Client Name Gam— PO # Job# <br /> Address S l=Ma+I Address .2 9 0 7-°0 4 a-°f �� Required OC Level p <br /> Fax <br /> City,State Zip Phone# 1 U I// IV <br /> b <br /> # <br /> J�! <br /> Time Date Malnx Office Use 5a fedby- Ort Attention ADO/EpF7 YES_ NO <br /> See Ke only r o 1,� o , r �o,� Total and type of <br /> Sampled Sampled See <br /> Lab!Q Number Fefd containers a Glabaf f0N <br /> Sample Description TAT Filtered See below REMARKS <br /> r r z 5 n <br /> OT -o I <br /> C <br /> 11 r�; <br /> 1130 <br /> 2-Y1,7,1-7- <br /> ADDITIONAL <br /> 1, R-7`ADDITIONAL INSTRUCTIONS <br /> Srgnat Print Name Company Date Time <br /> Re1mq ed b <br /> Receivedb `mss �`�` �7_�e 1 cis t�r u r•o...�r e K !.� ( l2lG��y /)14ZtiJ SPO /�c7 <br /> Relinquished 6y <br /> Received by V <br /> 6r <br /> Relinquished by I <br /> Received by <br /> "Key AQ-Aqueous <br /> SO-Soil WA-Waste OT-Other L-Lrter V-Voa S-Soil 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 analysis <br /> of the above samples is applicable only to those samples received by the laboratory YAth this coc The Mbillty of the laboratory is limited to the amount oaid for the ronnrt <br />