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G• Alpha -aa+f+H,ca %,uj#e lea Prom Which State? <br /> Name '�Iff- 3 �!a p Analytical, Inc AZ CA NV_ WA <br /> Address -7 �,. 255 Gle venue Suite 21 ►p OR_ OTHER �# of . <br /> Sparks,�a 89431 5778 <br /> City State Zip i ✓c I� Phone (775)355 1044 <br /> Phone Number' "6'IG" 'G' Fax Fax (775)355-0448 Analyses Required <br /> Client Nam Job <br /> Pop 0 �6 7 / 4 <br /> r J+ <br /> AddressRequired OC Leveh <br /> EMadAddress �1.� � <br /> Coy State Zips/ee ! � Phone a Fax `E �i,J M I it //I IV <br /> TIRI$ bete fAatc>s oftzeUse S2rhFedby , v.Y +1 1 t ISOVIEAF7 YES_ No_ <br /> ,� Report Arenliar [� <br /> Sampled Sampled Gee Key Only �"'� ,5 �J�� Tolai alai hype o} <br /> TATaConl ' r5 Gob105elow Lab D Number Sample " e <br /> r <br /> See be10%, i� REMARKS <br /> P1 tv- Or <br /> !u, <br /> ADDITIONAL_ INSTRUCTIONS <br /> Sign r print Name <br /> Rela�apwshe � � / � Company Date <br /> Time <br /> ReceiJ — tet - ! z vC;<<r <br /> f <br /> Rel3ngaiishetlby,--' ' --ALP On Z Z� <br /> Evei,ed by - - <br /> r / <br /> Relinqu+shed by r <br /> Received tv <br /> 'Key AO-Aqueous SO-Soil WA Waste OT-Other '" L-Liter V-Voa S-Soil Jar 0-Orbo T-Tedlar 8 Brass P-Plastic OT-Other <br /> NOTE Samples are discarded 64 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 />