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Billing i rmat on _ Alpha Analytical, Inc. Samples Coll ed From Which State? <br /> 0 . <br /> 9 /� p Y AZ_ CA NV_ WA <br /> Name . '"" y 255 Glendale Avenue Suite 21 1D OR_ OTHER page of - <br /> Address " P'ft— Sparks Nevada 89431-5778 <br /> City State lap Phone (775)355-1044J_ Analyses Required <br /> Phone Number Fax Fax (775)355 0406 Y05420 <br /> Client Nam J e'l C' .� PO # uoY OP l_ 0 I Regwred QC Level? <br /> Address EMail Address `v 1 !! /it !V <br /> City State Zip �,7k_�k Phone M <br /> Fax# `� Iv,(� EmviEDF7 YES_ No— <br /> Time 0a1e ]Matnx G Office Use Sampletl by / L ReportAtienbon � Tolal and type of v r Y f1�1 <br /> Only 1 crod.r rD M <br /> 5ampeed Sampled See Key y containers <br /> Below Lab ID Number Sample Description TAT 'e See b0aw REMA 5 <br /> of rkl c.✓-- ( /� <br /> ADDITIONAL INSTRUCTIONS <br /> a Print Name Company Date /Time <br /> Rehn ed b <br /> Received by �� •� t!r� ���� ��z �~ <br /> Relmquishe by , <br /> Received by in F 1�5 to 5D <br /> Relinquished by <br /> Received by <br /> .Key AQ 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 at 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 lability of the laboratory is limited to the amount paid for the report <br />