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Billing Ingr 1 on `�/� Alpha IytiCal 1170, Samples Collected From Which State <br /> 77 AZ,� CA,,�C N V_ WA <br /> Name r� 255 Glen, venue,Suite 21 jp OR_ OTHER P of N <br /> Address A Sparks, Nevada 89431-5778 <br /> City,Stale Zip [A- _ Phone (775)355-1044 J <br /> Phone Number N d ax T' 67 (7a Fax (775)355-0406 Analyses Required <br /> Client Name /( PO Job tt <br /> c.:U l Required OC Level' <br /> Address EMail Address 1 11 111 IV <br /> City State Zip O ( (� Phone p Fax# l} <br /> !�\ EDD/EDF7 YES_ No_ <br /> Time Date Matux Office use Sampled by f Peport Attention Total and type of !y /�~1 - <br /> 5ampled Sampled See Key Only 1 'G containers <br /> I crob,r rD r <br /> Below Lab ID Number Sample Description TAT ueirea See below <br /> REMARKS <br /> 5-V 5, r- <br /> j a5l 1k 14a 4571 5--V <br /> ADDITIONAL INSTRUCTIONS <br /> Signature Print Name Company Date Time <br /> Relingws y f�(� W,, tr r Z l� (�Lt J 3 lj <br /> Receiv y L <br /> Relinquished by (�' . p <br /> Received by T), LtR <br /> Relinquished by <br /> Received by <br /> 'Key AO Aqueous SO-Sod WA-Waste OT-Other "' L-Liter V-Voa S-Sort 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 /> I <br />