Laserfiche WebLink
Billing Info_r a 'on: Samples Colle From Which State? l� <br /> Name IL Col Alpha Analytical, Inc. AZ CA NV_ WA <br /> 255 Glendale Avenue,Suite 21 to OR OTHER fis9 e# or <br /> Address w Sparks,Nevada 89431-5778 <br /> City,State,Zip �1 `} %� �} Phone (775)355-1044 <br /> ld <br /> Phone Number ` Fax Fax (775)355-0406 Analyses Required <br /> Client NameTW P.O.k Job# <br /> T 1 Required QC Leve!? <br /> 0 c- <br /> Address Wall Address v <br /> 1311L l i ! L l G N �}vY1 ( ",�l i L 'vl L , t_L's1 ` h r rr rrr ry <br /> City,State,Zip r 54C t4 <br /> r ^ Phone# I ax# _ "21 7S/ av f E' fpo/_ yes— o— <br /> Matrix' Sampled by Report AttWion <br /> Time Date Matrix' <br /> See Ke conlai of r�� �� ` crown tor <br /> Y <br /> Sampled Sampled Below Lab 1D Number Uorro Sample Description TAT .d • See below f REMARKS <br /> I�e1 `" I1 1' <br /> 2. - Z- - <br /> F - <br /> JZJZ , Z <br /> 3_ <br /> Z <br /> 44 <br /> 3 ' Vv \V . .I. I i . <br /> O ADDITIONAL INSTRUCTIONS: �'',(� /4C�[ � G+=t',� ( ',Qh'! �4S !S Z —f ' E k L— C <br /> Sif nature Print Name Company Date Time <br /> Relinquished by 'rt+ o C C_ 67 <br /> Received by �I S <br /> Relinquished by �L <br /> Received by <br /> Relinquished by <br /> Received by <br /> `Key: AQ-Aqueous SO-Soil WA-Waste OT-Other AR-Air ": L-Liter V-Voa 5-Soil Jar 0-Orbo T Tedlar 8-Brass P-Plastic OT Olher <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 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 />