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Billing Informat an Alpha Analytical, Inc <br /> Name 255 Glendale Avenue,Suite 21 Page# of <br /> S arks,Nevada 89431 5778 <br /> �'� Phone (775)355-1044 <br /> Address *� :�tr EG-r,1� ! sr�r.A �—ti =r� . P <br /> City,State,Zip �� ,/ �., w 'f a <br /> ''� <br /> Phone Number 0 A?' K122' Fax -�'? tt Fax {775}355 0406 Analyses Required <br /> Client Name j .? P O # Job#6 r <br /> Addres�/ `N aev PWS# DWR <br /> City State Zip ' Phone# Fax# s f <br /> Time Date WtrD(* Ofrice Use Sampled by Report Attention Totalandtypeof t � <br /> Sampled Sampled See Key only oontamers l� ` <br /> Below LablDNumber Sample Description "Seebelew � _' RE=MARKS <br /> —nr <br /> I <br /> ADDITIONAL INSTRUCTIONS' <br /> Si nature„ Print Name Company Date Time <br /> Relinquished by Received by C�tL CSL/� C- �r�!``i✓Ct +> ��� <br /> Relinquished <br /> Received by <br /> Relinquished by , <br /> Received by S' ( <br /> -� IT ' <br /> Ji 1 �r f>l �f (]�7 _✓ <br /> Ked: 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 /> NOTE' Samples r dis6arded 60 days after results are reported unless other arrangements are made Hqzardous samples will be returned to client or disposed of at client expense The rep for the analysis <br /> of the above sas applicable only to those samples received by the laboratory with this coc They of the laboratory is limited to the amount paid for the report 0 <br />