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5 Vv v ,�,r1.o.,1110E y u�.a,, 111%,. AZ_ CA� NV WA <br /> Name _ _ � 255 Glend venue,Suite 21 <br /> Address 5 •`!v1 1� Sparks, 89431.5778 <br /> - !D OR_ OTHER F of <br /> r✓ <br /> City,State,Zip �� " `` Phone { 5-1044 <br /> Phone Number �,�.rr 7�-k2,x" ax _ ��!1 �i��v�J Fax (775)355-0406 Analyses Required �- <br /> ty �.. <br /> Client ttame . . // � P.O.# Job# <br /> 1 Required QC Level? <br /> Address EMail Address <br /> 1 11 /it IV <br /> City,State.Zip /_./ r Phone# Fax# <br /> L.t Foai enr?YES_ NO <br /> Time Date Office Use Sam !fib A rtAiten! ^ <br /> dairx' p Y J� [r Total and type of <br /> Sampled Sampled See Key Only r ' ♦'old <br /> contairers ' G�abe11D r <br /> Below Lab ID Number Sample Description TAT nrered 'See below 'n <br /> _ _ REMARKS <br /> L <br /> L(K - <br /> 3 <br /> ADDITIONAL INSTRUCTIONS: <br /> a e Print Name Company Data Time <br /> Relin <br /> Receivedny — 7 HAL � `"'� t7 <br /> P=Gr,gts=.sh d hyf. .� <br /> 11,0 <br /> Rec_�ied ey <br /> 'Key: AQ-Aqueous SO-Soil 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 anplicabie only to those samples received by the laboratory with this coc. The liability of the laboratory is limited to the amount paid f^r the reeort. <br />