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•o ,IG r n V�r pr•roc a i (r T .._--1-.��.I "'v. <br /> 255 Glendale Avenue,Suite 21 ID CA— NV WA ' <br /> Address � 4.»e Von Pt ,dr, S 4,r � !D � 014� OTHER <br /> Spar vada 89431-5778 — <br /> N city,stat GA.h+trip Bi.,K C. ?SL B' Phor 5)355-1044 <br /> Q Phone Number 3OG7Ltro�Y Fax y4600� Fax (775}355 04Dfi Analyses Required <br /> Client nramE _ <br /> u 514 6S <br /> P.O. �0bq <br /> Address EM AAddress 26 4D?—to a i D <br /> -ar Required DC Level? <br /> i <br /> City,State,Zfp N ! 104:—*) ly <br /> Lal r Phone# Fax# <br /> tic,... <br /> Matrix' Office use Sa d b EDD/EDF'!Yes )e xa <br /> Time Date y� R Atlenlion• � -- <br /> • ; D l&- d p Wal and 1 e of <br /> Sampled Sampled See Key Only �'' k'oW 4 containers �Gro6arID,TD a40 <br /> m Below Lab ID Number Sample Description TAT FaaMed "See befmv REMARKS J� <br /> o aha o r LAS)? "_ r4 �T >r* 5 <br /> _ <br /> (D b.S S <br /> rs 76P �...�t LL S 14 63 r7 <br /> M <br /> cr <br /> ro <br /> �o <br /> 0 <br /> n <br /> C <br /> a_ <br /> M ADDITIONAL INSTRUCTIONS: <br /> Sign r Print Name <br /> Company <br /> Relinquish 6 tale Time <br /> rLe <br /> D Received by <br /> ,. Relinquished by <br /> D Oquished b <br /> r) Received by <br /> 7 <br /> `Key: AQ-Aqueous SO-Sail WA-Waste OT Other L-Liter V-Voa S-Sail,far O-Orbo T-Tedlar B-Brass P-Plastic OT-Other <br /> u 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 anal sis <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 lhA ronne y <br />