Client Name of samples Sample Numbers list all or range Sample Code see below Prep Code if required Pkg Code Element s Page of Sample Codes R Rock H Humus B Brine C Ore Conc LS Lake Sediment CR Crushed Rock S Soil MW Marine W ater O Other specify SS S tream Sediment HMC Heavy Minerals V V eget ation W W ater P Pulp Please copy p age for additional sample list s Sample Prep aration Charges Cont act me if sample prep aration is required I authorize any required sample prep aration charges FOR F ASTER TURNAROUND TIME EMAIL A COPY OF YOUR SUBMITT AL FORM T O samplereceptionactlabscom