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Billing Into t on ��� Alpha lyttcal, Inc <br /> Name_�� � 255 Gien venue Suite 21 <br /> Page# of <br /> Address f Sparks,Nevdda 89431 <br /> City,State Zip Ve it/ v APhone (702)355-1044--f Lit v' <br /> Fax (702)355-0406 v Analyses Required <br /> Phone Nurnbees> nca 6,9.1 Fax <br /> Client Name Aaew a eW PO # Job# <br /> Address PWs# DWR# �q <br /> City State Zip Phone# Fax# <br /> Time Dale Office Use 5ampl d y Repor!Al4ntion Totalandtypeot X <br /> Sampled Sampled See Key only J r7 P/ J.9 containers �4 <br /> BON Lab ID Number Sample Description "See below EZ REMARKS <br /> d4 IV <br /> UALD <br /> —10 7TA- <br /> ��s S <br /> .f <br /> �0 <br /> ADDITIONAL INSTRUCTIONS- <br /> Signature Print Name Company Cate Time <br /> Relinquished by <br /> Received by , � <br /> Relinquished by <br /> Received by <br />' Rehnquis ed b <br /> F Recerved by <br /> 'Key AQ Aqueous SO-Sal WA-Waste OT-Other '" L Liter 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 abeve 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 the report <br />