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Btiltng s--t��o---rm Alpha Ancai, Inc - <br /> Name ' <br /> r`` r 255 Glendale e,Suite 21 Page# of <br /> Address L.0 [� vim fZ- ,j�/ Sparks,Nevada 89431-5778 ' <br /> City,State, cr Phone (775)355-1044 <br /> Phone Number Olm4l7&- Fax Fax (775)355 0406 Analyses Required <br /> Ghent Nam PO # J # / <br /> Address 3 a PWS# DWR# t� <br /> City State Zip-7,���t�L �� Phone# Fax# <br /> J Mft* Office Use Sampled by / � Report Attention �` f � <br /> Time Date Only �'--[ r ) �`vlv �' �otalandtypeof J N <br /> Sampled Sampled See Key y containers <br /> Below Lab ID Number Sample Description See below REMARKS <br /> i <br /> ADDITIONAL INSTRUCTIONS' <br /> Si u Print Name Company Date Time <br /> Relinqu db ,%� * � �O[ !12�;,;7 <br /> Recei12 <br /> ve y /, {. <br /> Relinquished by <br /> ELI <br /> Rebnquished by <br /> Received by <br /> 'Key AQ Aqueous SO-Soil WA-Waste OT-Other L Liter V-Voa S Soil Jar O-Orbe T-Tedlar B-Brass P Plastic QT-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 />