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Billing I for ' tion Alphlyttcal, Inc. ��77 <br /> Name t 255 Gle Avenue,Suite 21 Page# I of 3 3-L 4, <br /> - L Sparks,Nevada 89431-5778 - <br /> Address �aav 5 Phone (775)355-1044 <br /> City,State,Zip Fax (775)355 0406 Analyses Required <br /> Phone Number Fax <br /> Client Name PO #� Job# <br /> Address <br /> O ` `! PWS# DWR# <br /> City State Zip n Phone# Fax# <br /> • <br /> Office Ose Sampled by C iieportAttent3on -t Totalandtypeof <br /> Time Date Only J V containers rV q <br /> Sampled Sampled See Key <br /> Below Lab lDNumber Sample bescnp on •"Seehelow �Q � �~ � REMARKS <br /> 4.115 3 Plk 5 0 SMS - M W1"_ 6 ✓ I/ <br /> C50 MWJ.6j,5 <br /> MW 7-4 <br /> 15 5 fAw I-]-IDD <br /> ADDITIONAL INSTRUCTIONS <br /> E__ <br /> Signature Print Name Company Date Time <br /> Relinquished by t 4 .45� - 3-3LY f 3 J p <br /> Received b -�� ?� ����L) <br /> Relinquish <br /> Received byj �36 <br /> Relinquished by <br /> Received by <br /> 'Key AQ-Aqueous SO-Soil 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 analyst <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 the report <br />