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Samples Collected From Which State? <br /> Name Bitting tnformatio� Alpha alytical, Inc. AZ CA NV WA <br /> i Name �' �� ri ran �•��+ �� ! � _ 255 Gler venue, Suite 21 <br /> Address 3 41okee.k PCa , cf u le 33b Sparks, da 89431-5778 OR_ OTHER !�_� � <br /> City,State,Zip au+w P;vK Ga 4 SLBz it Phone (775)355-1044 -7 <br /> Phone Numberwr3B LTL-LpaY Fax 5.30 L7C-tcof•� Fax (775)355{}406 Analyses Required s <br /> Client Name P.O_# Job# <br /> LLS r G 2007^0o4f 0 C �� MIE01 <br /> Required QC Level? <br /> Address Email Address y' it 11! IV <br /> City,State,Zip Phone# Fax# <br /> A. <br /> /EDF?YES x NO <br /> Time bake Matrix' Office Use Sam ed by e�ortAttenton TOf31 and type of <br /> Only • f a��•h Gown r-.0 .a. �� )m�r�Sampled Sampled See Key Y containersBelow Lab fD Number Sam le Desai lion TAT Feldp p Pilfered "See belowREMARKS <br /> 1.2Y9 7I dr ��►4 L s J4 X F r ?� <br /> 1Z`f'� 443,4 45* 4 S s :r•..A <br /> zyhf iA:r <br /> ADDITIONAL INSTRUCTIONS: <br /> C. <br /> x <br /> Signature Print Name Company /Date Time <br /> Relinquished rv,� �S7'a�Lr,��ecs 1 ,�• ��/ 71 - <br /> Received by �xti. n1 �� rN 1 NAS ., y s <br /> Relinquished by f <br /> Received by <br /> Relinquished by <br /> Received by <br /> 'Key: AQ-Aqueous SO-Soil WA-Waste OT-Other ": L-Liter V-Voa S-Soil Jar O-Orbo T-Tedlar 13-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 /> UhL_ J <br />