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Bfllsn fo' Samples Collected From Which State? <br /> 1�t1 Alpha AlAtical, Inc. AZ CA 1/ NV_ WA <br /> Name "�� 255 Glendal enue,Suite 27 <br /> to OR_ OTHER Page� Z of <br /> Address Poik Of. Spk%) Sparks Nevada 89431-5778 <br /> City State Zip Z Phone (775)355-1044 <br /> Phone Numbe Fax blk-600_ Fax (775)355 0406 Analyses Required 10997 O p A 7 <br /> 7 7 <br /> Client Name Pu�15 PO it Jobn ,�hV„ rJ2 <br /> I "iJ) Required QC LevelI <br /> Address �lrJh 1 EMailAddress <br /> t I 1 1! !!l IV <br /> City State Zip [ Phone p Fax q V <br /> 7 L v <br /> IECO)DIEDF?YES_ NO_ <br /> Time Date Matrix* Office Use sampled by .L1 Report Atten�on wri Total and type of ti ar'ID <br /> rI <br /> Sampled Sampled See Key Only �M Fetid containers r <br /> Below Lab ID Number Sample Description TAT ,nB1� "See below } REMARKS <br /> 3 .s 9-kZ 4a 00Tlul-yW <br /> -v JA-L 51) 1' 6- 5 <br /> RAJ -AC -S w -7-V -T,At, <br /> � ��L �BZW —V ✓ ✓ <br /> -FT-1 I I.- I <br /> ADDITIONAL. INSTRUCTIONS. <br /> SignatW Print Name Company Date Time <br /> Relinquished by C 9j3_-0_f <br /> �f It 0 <br /> Received by , `J rC—/3–(XLn o <br /> Relinquished by v <br /> ra <br /> i 3 a <br /> Relinquished by <br /> Received by <br /> "Key AQ Aqueous SO-Sod WA-Waste OT-Other L-Liter V-Voa S-Soil,lar 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 for the analysis <br /> of the above samoles is anohcahle nnlv to thnsp samnles rerewpel by the tahoratoiv with thio rnr Thp tiandity of the lahoratory is limited to the amount Dald for The report <br />