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D1111"Y rm tor>� Alp nalybcal, Inc <br /> Name �� I <br /> Address .�� Sp le Avenue,Suite 21 Page# of I <br /> Sparks—,Nevada 89431-5778 <br /> 4 8- <br /> City,State,Zi 'l Phone (775)355 1044 �• <br /> Phone Number Fax A' l��� Fax (775)355 0406 _j Analyses Required <br /> Client Nam C P p # JOL# <br /> Address ql / fW c� PWS# <br /> Y J iL DWR# l 1 <br /> City Sta e Zip ! V <br /> owl, Phone# Fax# <br /> Time DatefbtOffice use Sampled 'f r ReportAttention� Total and type of J �t <br /> Sampled Sampled See Key Only 4' , containers f) <br /> f Below Lab ID Number p Sample Descnpbon 'Seebeiow s REMARKS <br /> VCW <br /> L)41 7:11 <br /> ADDITIONAL INSTRUCTIONS- <br /> Print Name <br /> Company Date Time <br /> Relmquis <br /> Received by r 3 <br /> Relingwshe by <br /> Received by <br /> � <br /> Relinquished by �1 •f~>J l �t�_... <br /> J <br /> Received by <br /> 'Key AQ Aqueous SO-Soil WA-Waste OT-Other L-Liter V Voa S-Soil Jar 0 Orbo T Tedlar B-Brass P-Plastic OT-Other <br /> !VOTE 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 />