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Billing���Jnfo�rm` — Alpha A ical, Inc . <br /> Name r `� °Lr `- <br /> 255 Glendale nue,Suite 21� Page#— _of <br /> [� G 4v� :,�-:�L ,�% Sparks,Nevada 89431 5778 <br /> Address r <br /> City,State,Zip �-����� i"'. �''��-�L � Phone {775}355 1044 _ <br /> Phone Numbers t-610r-7 Fax �(�����i' Fax (775)355 0406 Analyses Required <br /> Client Name PO # Job N NJLfi <br /> Address PWS# <br /> DWFi# }' <br /> City,State Zip Phone# Fax# <br /> Time Date MftSe Key Ofice use 5a Report enhQn �� �� r�-7 7GC LC c/ <br /> Only �LL� �--7,•�-- Total and type oi � +* r <br /> Sampled Sampledcontainers <br /> rP 1 Below <br /> �� Lab 10 Number Sample Description -seebelow � REMARKS <br /> C 7r �I "!d 4) ?�-,311 L`—L I i 4--Cik ("k C--) - I <br /> I <br /> ADDITIONAL INSTRUCTIONS' <br /> Signature Print Name Company " Date Time <br /> RE r Vy ed by f <br /> • 1 <br /> ^� pfrx�`"'�!'(L. �/ �► -'� Com . i c� �J1�i' <br /> Recei �tt �` <br /> Relinquished by <br /> Received by <br /> Relinquished by , <br /> Reeetved by I <br /> 'Key AO-Aqueous SO-Soil WA-Waste OT-Other L-Liter V Voa S-Solt Jar 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 analysis <br /> of the above samples Is applicable only to those samples received by the laboratory with this rnr <br />