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Billing Into ion: _ Alpha lytical, Inc. Samples Collected From Which State <br /> Name . . { Cr! Jr A! O,0417d%,( 255 Glenda Avenue,Suite 21 AZ CA NV CA WA page � <br /> Address 3 3.30 G..,tt c�o., �� Y7/., Soc o .SSD Sparks,Nevada 89431-5778 ID OROTHER_ a I'. o/ <br /> City,State,Zip rA Y,_r SG&Z Phone (775)355-1044 <br /> Phone Number-130 A7L-G,aay Fax XJ0474-40DS Fax (775)355-0406 01 Analyses required , <br /> Client Name P.O.# Job <br /> u S A 6.S_ a o o _ ! Required CC Level? <br /> Address Entail Address <br /> Ill IV <br /> City,State,Zip Phone# Fax k <br /> EDD/EDF?YESk NO <br /> Time Gate Matrix' orrice Use Sam by�. R Bention. lotai aatl type of <br /> Sampled Sampled See Key Only .c•, d( dW r r ��st aJ i a containers r► p C a 7aa <br /> n GrobsrfD <br /> Below Lab 10 Number Sample Description TAT Fr'ere7 "See below J�q REMARKS <br /> y30 alai oT yTR(? iru DZ - 54 Gt 5 RLs R _7,f S / 7- <br /> 5 <br /> 5 <br /> Yzo o f us �r is tom!' Al y 4, . i/;✓7 <br /> I <br /> I <br /> ADDITIONAL INSTRUCTIONS: <br /> Signature Print Name Company Date Time <br /> Reiinquished by <br /> Received by _ <br /> v �4 w d{ S"rr 1 a t J• I v-,G-D� I.5-Yt? <br /> Relinquished by <br /> Received by <br /> Relinquished by <br /> Received by <br /> `Kev: 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 laboratory with this coc. The liability of the laboratory is limited to the amount paid for the report. <br />