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Samples Collet From Which State? • <br /> Billing In>lation. _ 1 Alpha Analytical, Inc. AZ— CA Nv_ wa <br /> Name 1 255 Glendale Avenue Suite 21 to -- OA,_ OTHER Rags of <br /> Address C,o Sparks Nevada 89431-5778 <br /> ' , Phone (775)355-104a <br /> City,State Zip Fax (775)355-0406 Analyses Required <br /> 06435 <br /> Phone Number{530 CIL tam Fax ��ia1C��_��i <br /> Client Name PO tl Job r Required OC Level? <br /> Address Entail Address - ti 1 11 Ill IV <br /> City State Zi P ne 0 Fax a LLLU EDt7/ED"YES NO— <br /> n - o 11 j �� <br /> Time Date Matnx Office Use Sampled Report Attention Trial and type ct nr1 (V Global 100— <br /> Sampled <br /> DrSampled Sampled Only caters ~ ~+ <br /> SOW Lab ID Number Sample Dewm%n TAT ;;d »See below REMARKS <br /> )y `' 0 Cx' v� J — S <br /> — — l <br /> f� °► C PT_ Z W <br /> P - til <br /> �5 I 9 r+ 5 S <br /> 91 �� - SCJ S 7 V <br /> V <br /> La 1 $ Z <br /> q) - L4 JT1 <br /> ie <br /> ADDITIONAL INSTRUCTIONS: <br /> Sig tura Print Name Company Date Time <br /> Relinquished by <br /> Remand by <br /> Relxtquished by <br /> Ned by <br /> Refurquished by <br /> Received by <br /> 'Key AQ-Aqueous SO-Soil WA-Waste OT-Other L-Liter Moa S-Soil Jar 0-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 tot the analysts <br /> of the above samples is applicable only to those samples received by the laboratory with this cot The hatmlity of the laboratory is limited to the amount paid for the report <br />