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Billing Information: Samples Collect rom Which State? 9 ^ 0 <br /> Name Alpha Analytical Inc. <br /> �' d 255 Glendale Avenue,Suite 21 Az CA NV WA <br /> Address ' Sparks,Nevada 89431-5778 ID OR OTHER page of <br /> City,State,Zip !�I - > q Phone (775)355-1044 <br /> Phone Number.SS 7— 2.)3_ `c`�/Fax 2 C Fax (775)355-0406 Analyses Required <br /> Client Name -�rl P.O.# Job# --r' <br /> r`� I(~ (^CJ Q` 17Z__ I✓� Required CC Level? <br /> Address EM it Address �` 1 ll III N <br /> city.Stat ,Zip , Phone# % ax# J o s \ <br /> ( h r� EDD/EDF?YES NO <br /> Matr%' Sampled by Report AttentionTotalJ Jl ! <br /> Time Dale See�y tairers°f croi ro r <br /> Sampled Sampled Lab ID Number once Sam le Description TAT F'"d <br /> { use onl� p p Fr#ered "See bebvr REMARKS <br /> .zzc� -I P , {, <br /> Q dZ►'] <br /> fir'1. <br /> 10ADDITIONAL INSTRUCTIONS: <br /> ignature Print Name Company Date Time <br /> � <br /> Relinquished by / L;, o7 <br /> Received by :- L . V /A j L1 7 c� <br /> Relinquished by c- <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,lar 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 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 />