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Samples Collected From Which State? <br /> Btlhn9Info atron Alpha Analytical, Inc. AZ CA X_ NV WA <br /> Name ��j`Us ��y' �/�G - 255 Glendale Avenue Suite 21 ID__ OR OTHER Page of <br /> Address G•mloic" Sparks Nevada 89431-5778 <br /> City State Zip (Ov"w 0+"' + C-An Phone (775)355 1044 = <br /> T Fax (775)355 0406 Analyses Required 06719 LCl 7 1 9 <br /> Phone Number Fax ! 7 <br /> Client Name P ) <br /> fs Job It Required QC Level? <br /> TO S I P 64.0 <br /> AddressEntad Address <br /> S O >7 So 4 1 11 111 1V <br /> City State Zip r b G k <br /> �.h� ? � Phone Fax a � IV) 40 Q � EDDlEDF1 YES IX No <br /> — <br /> Matrix Office use Sampled try Report Attention Total and type of � % � & f <br /> Time Date Only O 4. k Q sfonr+ns <br /> Sampled Sampled Key y Field containers Q. "l REMARKS <br /> BEFow Lab iD Number Sample Description TAT r•,rrered See below ``' 11-+ <br /> K X X <br /> ,'►w <br /> tN ,Jt <br /> !v <br /> W <br /> a WOE Z <br /> xo -I O — •✓ <br /> ADDITIONAL INSTRUCTIONS. <br /> Signature Pnnt Name Company Date Time <br /> Relinquished by ' <br /> Received by �` s Gi ONyt 0 <br /> Relinquished by <br /> Received by <br /> Relinquis ed y <br /> Received by <br /> 'Key A4-Aqueous SO-Soil WA-Waste OT-Other L-Liter V Voa S-Soil Jar O-Orbo T-Tediar B Brass P-Plastic OT-Other <br /> NOTE Samples are discarded 60 days alter 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 />