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Billing lnfornow Alpha An cal, Inc. <br /> Name 255 Glendale AV nue,Suite 21 Page#�___of <br /> Address i Vic✓ r vrn..✓`�'� '" Sparks,Nevada 89431-5778 <br /> Phone (775)355-1044 <br /> City,State,Zip � r,! Fax (775)355 0406 Analyses Required (� <br /> Phone Nu �' <br /> mber - � Fax � ��r/�'z'�� r <br /> Client Name —7,�' PO # <br /> Address PWS R DWA# <br /> City State Zip Phone# Fax# -F"F <br /> Time Dale MaW ONOn Use Sampled by /L r RepartRtteniion Total and type of <br /> Sampled Sampled See Key fl"�y L~ containers <br /> Below LablDNumber Sample0escriplion "See below REMARKS <br /> oao5a a - 6 r ��u/- ( v <br /> ivy 4. }� 1v1 ti- - 7 <br /> ADDITIONAL INSTRUCTIONS <br /> 711 <br /> re Print Name Company Date Time <br /> Relinquishe y / t�. r �, �� <br /> Rece <br /> Rel[hrwished by '\ <br /> Relinquished by <br /> Received by <br /> 'Key AO-Aqueous SO-Soil WA-Waste OT-Other it L Lder V-Voa S-Sod Jar 0-Oibo T-Tedlar B-Brass P-Plastic OT-Other <br /> NOTE Samples are discarded 60 days after results ate 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 /> i i,, ki.,,,,i„in ti-,nen cnmrlta z raepivPrl by the lAhnratory With this r nr The liability of the taboratory is limited to the amount paid for the report <br />