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Billing infoation Samples Collet d From Which State? • <br /> Alpha Ana ytfcal, Inc Az CA NV_ WA <br /> Name ^ 255 Glendale Avenue Suite 21 lD OR_ OTHER Page# Df <br /> Address 3� �i��,o Fes{ �r�5 [, Sparks Nevada 89431-5778 <br /> City State,Tap Phone (775)355 1044 <br /> Phone Number 3a Fax Fax (775)355 0406 Analyses Required 05442 <br /> Chent Name PO # Job <br /> io 7,G0 t)IR15 0 Required QC Level? <br /> Address EMa4 Address <br /> o r 11 lir lV <br /> City State Zi Phone# Fax p <br /> 5 Z EGD/EDF?YES HO� <br /> Fiore bate Matrix* Office Use Sam ed by piienbon T_ <br /> On !PAZ I . Pahl and type of v <br /> Sampled Sampled BeloSee w ty Lab ID Number Sample Descriptan' ' TAT FFne a See belrnw ners `+ w a' �r�.r rD <br /> REMARKS <br /> SD �} �� `(d _ S 6 <br /> 9 r -1� <br /> 6 li3 64 ' FT— S <br /> ADDITIONAL INSTRUCTIONS: <br /> i <br /> Si nature Print Name Company Date Time <br /> Relinquished by <br /> Received by 0 <br /> Relinquished <br /> A <br /> Relnquished by <br /> Received by <br /> 'Key AQ-Aqueous SO Soil WA-Waste OT-Other L Liter V-Voa S-Sod Jar O-Orbo T Tedlar B-Brass P-Plastic OT-Other <br /> NOTE Samples are discarded 60 days atter 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 />