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Billing Infor n Alpha A tical Inc Samples Col!ec d From Which State? <br /> Name 255 iendal venue,Suite 21 AZ CA UNV WA <br /> !D OR OTHER Page# 1 of_I <br /> Address 3%3o grk [�c^�„�_ ASO Sparks,Nevada 89431-5778 <br /> City State Zip Phone (775)355 1044 <br /> Ci <br /> Phone Number(53a)G�11,- rQom Fax {j i)rG��. =S Fax (775)355 Qa06 Analyses Required 6510 <br /> Client Name g 7 PO # Job r Required OC Levels <br /> Address EMail Address <br /> o r 11 Al IV <br /> City Stale Zi / Phone All Fax <br /> 'Sin zALJ ; EDD <br /> YES NO <br /> Matnx' Office se Sampled by Report Attention 7and�pe a � N 'tTime Date ctoaerrDrSampled Sampled See Key Only F1eidBelow Lab ID Number Sample Description TAT FBeed REMARKS <br /> Mfr` - ► C pT- 5 <br /> l3x1i9 1 A G,I5 <br /> ar <br /> � N <br /> 49 _ t t <br /> L4 G ) 5 j <br /> ! 2ol <br /> ADDITIONAL INSTRUCTIONS <br /> Signature Print Name Company Date Time <br /> Relinquished by Q _ D <br /> Received by <br /> S A <br /> Relinquished <br /> by <br /> Relinquished by I IF <br /> Received by <br /> 'Key AQ-Aqueous SO-Sod WA-Waste OT-Other L-Liter V-Voa S Soil Jar 0-Orbo T-Tedlar B-Brass P-Plastic OT-Other <br /> NOTE Samples are discarded 66 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 analysts <br /> of the ahnvP camnlPe ie annhrahlP nniv to thnea eamriiPc rPrpivind by the lahnrpfnry with thic rry Tho Ismhdity of the lahor0r%ry r4 limifed to the amntinf nam fnr the rpnnrt <br />