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Names 4 oma on Alpha A lytical, Inc. ! / <br /> 255 Glen enue,Suite 21 1 . <br /> Address G ,✓'(Jt2 / Sparks,Ne a 89431-5778 Page# of <br /> City,State,Zip .�� Phone (775)355-1044 <br /> Phone Numberi'7, V ©J Fax (775)355-0406 Analyses Required 0 794 6` <br /> ClFent Na <br /> 'Gl PO # Job# til <br /> Address PWS# <br /> DWR# <br /> City State Zi f r �� Phone# Fax q I\ <br /> Time Date Mft- ]['—Office Use Sampledr ReportAttemro T U <br /> Sampled Sampled See Key Only l v Totalandtypeof q <br /> co in <br /> Below LahIDlVumher Sample Description **See below `� REMARKS <br /> 13 ±:1 � lRr- � J`✓ rt.• <br /> ADDITIONAL INSTRUCT S• <br /> Si ur <br /> Print Name Company <br /> Rehnqut�d by' p Y Dale Time <br /> �`' -� 17 / <br /> Receive y All -/ 7,q <br /> Rellnquishe by <br /> �< t zj~ <br /> Re e v h <br /> Relinquished by <br /> Received by <br /> *Key AO-Aqueous SO-Soil WA Waste OT-Other ** L-Liter V-Voa S-Sod,lar 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 analysts <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 thinnmmint nnid f,,.fko--.4 <br />