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Billing lr1#armatioh: Samples Collect rom Which State? I <br /> b Alpha Analytical, Inc. AZ CANv WA <br /> Name 255 Glendale Avenue,Suite 21 <br /> AddressSparks,Nevada 89431-5778 ID— OR OTHER Page# C;' ofv <br /> City,State,Zip y Phone (775)355-1044 <br /> Phone Number^S���jZ�35Y Ji Fax Z Fax (775)355-Ud06 Analyses Required <br /> Client Name ���y PO.p Jab N 7 <br /> p — 172— <br /> f 2— f n Required OC Level? <br /> Address f eu EM it Address "�� ! It tri 1Y <br /> 71Cnt /tl !L•C r� <br /> City,Stat .Z ! �� /t! /�O Phone a �Y 2- ax>t 7 J- {� Y f�� <br /> r�--- S 2 / r' EDD/EDF? YES— NO <br /> Time Date Matrix' Samp ed try Report Attention Total and fYPe of �+f <br /> Gfoihaf!D,e <br /> Sampled Sampled SB iow Lab ID Number orrca Sample Description TAT Fend containers �� <br /> ( useon p p Phered "See below /REMARKS <br /> ALL <br /> 9ZZ 1Vi0 -� � .- e <br /> Lt 4Z <br /> ADDITIONAL INSTRUCTIONS: <br /> . ignature Print Name Company Date -7 [Time <br /> � <br /> Relinquished by C 1 i l�' C (a. 4 L�j 0 r— 12, 1 <br /> Received by I L l I L-1 7L\) <br /> c <br /> Relinquished by <br /> Received by <br /> Relinquished by <br /> Received by <br /> 'Key: AO-Aqueous SO-Soil WA-Waste OT-Other AR-Air ": L-Liter V-Voa S-Soil Jar O-Orbo 1 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 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 />