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Samples Collected From Which State? <br /> Name lnfiarmati n: 7 Alpha lytical, Inc. AZ CA_� NV— WA <br /> Name l LG5 f'$4 01✓o01 �aK t1, <br /> 255 GlendWenue,Suite 21 ID OR OTHER POLL—Of-4 <br /> Address 33 C 4N+-e re-j PY,. f}!- Sar c ,�5 D Sparks,NeMa 89431.5779 <br /> City,State,Zip C4 M c e a-1 0 jk.+Y CQ SL S Z Phone (775)355-1044 <br /> ty F Fax (775)355-0406 Anal ses Required <br /> Phone Number,13 0 4 7 4-L o o Y Fax �.7 t+7 d-4a o 5 Y Q a. <br /> Client Name 5 A G P.o.u b u9-dG erg r + Required I Level? <br /> Address Entail Address I;ZJ it /it IV <br /> City,State,Zip f Phone# Fax a <br /> 4 EDD/EDF7 YES k NO <br /> Time Hate Matrix' Office use sago d Q C ggponAttention y Tolai and type of �� 0 <br /> S y !� Ow r 1 1�-a++�X 4 conte ner5 Grodar ro76e.O 7T 06D 4 <br /> Sampled Sampled See Ke Only Field <br /> Below Lab 10 Number Sample Description TAT ,reared '50 below �� � REMARKS <br /> 9107- U S R 6 6. 19 s r1-r lT X X <br /> I N5, 1c,5 4 6.157 A <br /> 115T 00403 - a6e4 45' r4 <br /> ADDITIONAL INSTRUCTIONS: <br /> Signature Print Name Company Date Time <br /> Relinquished byDo b& )=� l K c5 T.^n. �*S `C'rt el. ^ _ 3— <br /> Recervedby jbct L rwu C 1 _.�� 1�0 <br /> Relinquished by _ <br /> Received by <br /> Re#inquished by /�~ <br /> Received by <br /> 'Key: AQ-Aqueous 5O-Soil WA-Waste OT-Other "": L-Liter V-Voa S-Soil,lar O-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 />