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SamplesCo!!ec d From Which State? • <br /> Billing WOW= Alpha Analytical, Inc p2 r CO NV wa T <br /> Name 255 Glendale Avenue Suite 21 <br /> Address 5 5� Sparks Nevada 89431-5778 !� OR_ OTNER Page�! Of <br /> City State,Zip_ _C,a'aC4Ar— ( A a 5 py z_ Phone (775)355 1044 <br /> Phone Number Fax 6Y.1�� S e—= Fax (775)355-0406 Analyses Required05443 <br /> Chen1 Name PO M Jobe Y RfQuflBd QC Level? <br /> 1158 �© <br /> Address ` EMad Address � � 1l 11j rV <br /> City State Zi Phone a Fax e <br /> EDD/E�YESMO <br /> Time pate Matrix Office Use Sari by ReportAttenhon t pe O <br /> rosal and �r N <br /> Sampled sampled See Key Only Frea containers 1 Global ro s <br /> Below Lab ID Number Sample Description TAT �,� • See below REMARKS <br /> 71 <br /> 7 Ira `� - az- S <br /> 1� 5 <br /> rec w ,r <br /> Ln '4 0 - - 51 7V <br /> c 9I — J <br /> ADDITIONAL INSTRUCTIONS <br /> Signature_ Print Name Company Date Time <br /> Relinquished by CZq <br /> Received by <br /> 1. <br /> Os <br /> Relinquished <br /> c <br /> Received by <br /> Relinquished 6y kj <br /> Received by <br /> 'Key AO Aqueous SO-Soil 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 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 />