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Samples Collected From Which State? <br /> Billing InfornAn Alpha AlOwtical, Inc AZ CA NV WA <br /> Name �° �- 5 I�•►tiEl►:��n -�Nt�-" ;� -- 255 Glendale Avenue Suite 21 <br /> Address 33c. o,.��' wr - SSD Sparks Nevada 89431 5778 ID OR OTHER Page# of <br /> City State Zip \t— Cpm S(ar6'L Phone (775)355 1044 <br /> Phone Number ER 1101(o koO—01 Fax C.4,co�c-- Fax (775)355 0406 Analyses Required 6832 <br /> Client Name PO t Job n Required QC Level?U 00 3, <br /> Address P'70 / n EMail Address 1 /it !V <br /> y �-�}-�vt.. ��v tj �t v r� N, 1 <br /> City State Zip / Phone# Fax# _y� ~ (J <br /> � FDA/EDF?YES J4 NO_ <br /> Time Date Mainz' Office 5pr�pl by a„ L4y� Rep Atien4 Total and type Df �' ry Gron,rrnr lD�o-7723�F�� <br /> Sampled Sampled See Key y M Fek containers <br /> Below Lab ID Number Sample Description TAT Filtered "See <br /> below REMARKS <br /> c S` C)S"D Z Q& -- a �,�t- If S Y aC X i <br /> 007 e3 W <br /> Av, <br /> -lv <br /> 0557 w- <br /> )105r 01 MW <br /> 114< 09 MW <br /> 1chair low 41. h <br /> ADDITIONAL INSTRUCTIONS <br /> gnature Print Name Company Date Time <br /> Relinquished by r 0110 <br /> { /yr <br /> Received byf'` ,�I 4IL, �1 Z <br /> Retsnqulshed by �i I <br /> i <br /> Recerved by S � y y� o� r 3 r, <br /> Relinquished 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 for the analysis <br /> of the ahnua eamrtlae ie nnnhr-2hia nnly to thnen enrnniaq rnr-aarari his tho lahnratnAr x dth thea Jnr Tha I and h .,f tha 1�tu,.�tn�r,e hr�rlo 1 in thn amri int newl{ter 11 a ronnrl <br />