Laserfiche WebLink
Billin form tion Samples Collet ed From Which State? <br /> Name �r� 5 CNV Alpha Analytical, Inc ,�_ ca NvT wa <br /> 255 Glendale Avenue Suite 21 ►D OR_ OTHER page of + <br /> Address c�rtrGrs Sparks Nevada 89431-5778 <br /> City State Zap r Phone (775)355 1044 <br /> Phone Number 5 f 7GG 7 Fax X' (� Fax (775)355 0406 Analyses Required 05577 <br /> Client Na C L � <br /> i P OY Job01 Zv y��� Required QC Level? <br /> Address/L;7Entad Address 9 !ll 1Y <br /> V1 \l <br /> City State Zip,5 fa"t!J Phone M Fax# <br /> !� � w� EDD/EDF?YES� NO_ <br /> Time Dale Matte Office Use Sampled I Report Attend �[ _ Total and type of �( '[V\ <br /> Sampled Sampled See Key <br /> Only L Imo'{ ��� containers � I1 WOW100 <br /> Below Lab ID Number Sample Description TAT ,rr� • See below }�1 RE=MARKS <br /> ADDITIONAL INSTRUCTIONS- <br /> Si Print Name Company Date Time <br /> Rehnquis y —d--) 0 S I <br /> Racery <br /> Regnquish <br /> ved by �t✓ 0L_ <br /> Relinquished by <br /> Received by <br /> 'Key AO-Aqueous SO Soil WA Waste OT-Other L-Liter V-Voa S-Soli Jar O-Orbo T Tedlar B-Brass P Plastic OT Other <br /> NOTE Samples are discarded 80 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 />