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Name n4e,-"U Alpha Anal tical, Inc ` <br /> 255 Glendal ue,Suite 21 Page# _—of 1 <br /> Address �Gro2fN - . �� Sparks,Neva 431 5778 <br /> City,State Zip • Gil ,>, .�vL l� C, Phone (775)355-1044 ' <br /> Phone Numbed ctJ Fax_ � Fax (775)355-0406 Analyses Required 07385 <br /> nt Name <br /> g�)':!,3 -77 + 1L(� Sit P O # Job# <br /> Address <br /> PWS# DWR# I <br /> Criy 5ta1? 1'Z t � J CkA .e _e� <br /> � Phone# Fax# �' � <br /> Z v 7-fTi <br /> Time Date Malik' OHiceUse 7INumber <br /> bl[ Report ion Q <br /> See Ke yr—r -L Z d r� ' F V Total and type of <br /> Sampled Sampled y Only <br /> Below Lab ID containers <br /> Sample Description .. below <br /> ! Y REMARKS <br /> V^ [\ <br /> t <br /> t <br /> (K <br /> ADDITIONAL INSTRUCTIONS <br /> Signature Print Name Company <br /> R q hed by p y Date Time <br /> Re ived by - LL v'{' z <br /> Relinquished by <br /> Received by W. f <br /> Relinquished by <br /> Received by <br /> 'Key AQ-Aqueous SO-Sol] WA Waste OT-Other L-Liter V-Voa S-Soil Jar 0-Qrbo 7 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 />