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Billing Information: y �palytica Alpha Analytical,Inc. <br /> Company: �Ef� ,� It Main Laboratory: 255 Glendale Ave,Suite 21 Sparks,NV 89431 Phone: 775-355-1044 <br /> Attn: W to Fax: 775-355-0406 (, <br /> Address: Al � x.00 (Q O) Satellite Service Centers: � � 13 <br /> City,State,Zip: IM1541,J <br /> `/ ro Northern CA:9891 Horn Road,Suite C,Rancho Cordova,CA 95827 Phone: 916-366-9089 <br /> Phone Number: Fax: Iyl �Gr• w Southern NV:6255 McLeod Ave,Suite 24, Las Vegas,NV 89120 Phone: 702-281-4848 <br /> ronme Southern CA:1007 E.Dominguez St.,Suite O,Carson,CA 90746 Phone: 714-386.2901 Page# of <br /> Consultant/Client Info: Job and Purchase Order I Report Attention/Pro ect ar! er: QC Deliverable Info: <br /> t' X17 P 1 <br /> Company: / - Job# TQo �� •"� -4_� Name: ""'� �� DnRequired? Yes/ No EDF Required? Yes/No <br /> Address: XZ;W _ Job Name: 9i 'R e_ Email Address: - V/f1 P ee/lr/'/dh Y"a��•C'��1 <br /> City,State,Zip: e4lb-5 1LI I P.O.#: Phone#: Global ID: <br /> Cell A Data Validation Level: III or IV <br /> Samples Collected from which State?Icircle one) AZ C NV WA ID OR DOD Site Other <br /> Anah sis Requested Remarks <br /> Qt <br /> / U <br /> h <br /> r <br /> r <br /> s <br /> Time Date Matrix" s o ' <br /> Sampled Sampled (See Key g p <br /> HHMM MM/DD Below ab ID Number For Lab Use Onl Sample Description TAT <br /> fir= Sa`43 [(-t^15 14 N0 IV vs <br /> rV No Wits <br /> iS D c g y v 3 iy-!S h/ n!® l✓ tS <br /> n/0 IV/Is <br /> t 3�0 ��t t air E 5cA Fr e{p //© [� s <br /> lla iv 5 <br /> 1 310 �j . N�jdr(Q rto IV asno <br /> X <br /> R 1 m <br /> 09. 110114,11 1111"-, <br /> e Ogag1 ¢p11v1 e �' £ <br /> ADDITIONAL INSTRUCTIONS: <br /> (field sampler)attest to the validity and authenticity of this sample(s).I am aware that tampering with or intentionally mislabeling the sample location,date or time of collection is considered fraud and may be grounds for legal action. NAC 445.0636(c)(2). <br /> Sampled B <br /> Relinqujshed by:(Sig re/Affiliation): Date: Time: Received y:(S' ture/Affiliation: Date:0I_ lull <br /> Relinquished by:(Signature/Affiliation): Date: Time: Received by:(Signature/Affiliatio Date: Time: <br /> QLD ! �t017 <br /> Relinquished by:(Signature/Affiliation): Date: Time: Received by:(Signature/Affiliation): FDate. Time: <br /> *Key: AQ-Aqueous 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 sample receipt unless other arrangements are made. Hazardous samples will be returned to client or disposed of at client expense. The report for the analysis of the above samples is applicable only to those samples <br /> ireceived by the laboratory with this COC.Th liability of the laboratory is limited to the amounti for the <br />