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Billing lnfor •on: Samples Collected From Which State?.� <br /> �. Alpha ical, Inc. AZ_ CA NV_ WA <br /> Name _tuS C!1_Jt ♦o■tM+~A s. <br /> Address.33.3o c. 255 Glendale Avenue.Suite 21 jp OR OTHER page# of <br /> T <br /> . S t iso Sparks.Nevada 89431-5778 <br /> City,state,Zp_. ems* e_f ew pRr ..*SSL a Z Phone (775)355-1044 <br /> Phone NumberS.30 k 7i-t P61( Fax � D L76-<ooS <br /> Fax (775)355-D406 Analyses Required <br /> Client Name P.O.M Job 0 <br /> tA S A 4.S" 007 e e 4 - / ar Required OC Level? <br /> Address Entail Address <br /> \V 11 111 1V <br /> City,State,-Zip Phone a Fax 0 <br /> eeeIIEDMF?resk No <br /> Time Date Matrix' Office Use samg by ReWgAaeribon• Total and type of `Y Q � ! �Q t e 7 yae <br /> 01 <br /> Sampled Sampled see Key Only f .c--t dC o.a r �^ containers 1� <br /> Below Lab ID Number Sample Description TAT �,aw 'See below REMARKS <br /> Y 3 0 '�� 07 o5io�7D — �9d s R cS' .�,F S 1 X <br /> lyz� 0� lisR 6S .4 S s <br /> ADDITIONAL INSTRUCTIONS: <br /> r <br /> Signature Print Name Company Date Time <br /> Relinquished by 14L d 1 Q J, I One D l Yfl <br /> Received by <br /> Relinquished by <br /> Received by _ <br /> 16- 1 ,572 <br /> { <br /> Refnquished by <br /> Received by <br /> 'Key: AO-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 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 laboratorywith this coc. The liability of the laboratory is limited to the amount nairf fnr tho rwnnrt <br />