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Billing Infar a on: Samples Colie From Which State? I ;� Q 0 <br /> Name �L C01 Alpha Analytical, Inc. AZ CA NV WA <br /> Address C 255 Glendale Avenue,Suite 21 ID OR OTHER pa e# of O� <br /> Sparks,Nevada 89431-5778 9 <br /> City,State,Zip ! S. Phone (775)355-1044 <br /> Phone Number ` Fax - 1 Fax {775)355 0406 Analyses Required <br /> Client Name - <br /> rL {(. L '(' / `� P.O.# Job# } � � .� � Required QC Level? <br /> Address /J + C Entail Address ( ��yi 1 11 It/ IV <br /> .Il? rile,r'i L � (� N - ,C l (l C:1�L- , �:• t U <br /> City,State,Zip,;- r Phone# ax <br /> # hr <br /> { CD F7 YES_Z so <br /> Time Date <br /> Malrlx' Sampled by Report Attention Total and type o1 <br /> See Key containers L /�, `. M Global 100 <br /> Sampled //Sa��mpled Below LabIDNumber u o Samp�fe/Description .y�TAT ' �� REMARKS <br /> 4 C`. .._. 4 vV .r�7 AU— 5f •1l{� � Cl,t <br /> -czI MzS <br /> 126 - 04 <br /> iZ IZ <br /> XZC 1 , - r S 3 Z <br /> ADDITIONAL INSTRUCTIONS: ��,27PC- ( CEc 4EL UM, "-�,S ~ q1!5 -j�7,Z- C Lt LjL HSC <br /> Si nature Print Name Company Date Time <br /> Relinquished by U e_-;[C (Lc. or I C_ dZ (3 7 <br /> Received by tAic- S vo—i L1 <br /> Relinquished by �.. <br /> Received by C, <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 0-Orbo T-TedOar B-Brass P-Plaslc 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 />