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Billing information-, / Alpha Analytical, Inc. <br /> Name v.A !"��> i i— ;.pe�1.;,;,: 255 Glendale Avenue,Suite 21 Page# of <br /> Address "x` -<"� p>��r ;_ ( •, fE t! Sparks,Nevada 89431-5778 <br /> City,State,Zip �- : U' Phono (775)355-1044 <br /> Phone Number {}6Fax (775)355-0406 Analyses Required <br /> Client Name Job# <br /> Address 1W. PWS# DWR# , l y <br /> City,State,Zip }�I Phone# Fax# <br /> Time Date wbix- Office Use Sa pl d by ; Re rtAttention <br /> See Ke Only Y ,'� v iF Total and type a! +yr ;"'aaa <br /> Sampled Sampled y containers f. 0Below Lab lDtsfumber Sample Description "Seebelow C'� l� 4.3 REMARKS <br /> f V 1 � I <br /> All Vtf <br /> i�N .a Vit. "J PVIA <br /> 41-557 <br /> 4 <br /> ADDITIONAL INSTRUCTIONS: <br /> Signature Print Name Company Date Time <br /> Relinquished by f <br /> Received by l <br /> Relinquished by <br /> Received by <br /> Relinquishedby f <br /> ,Received by <br /> 'Key: AQ-Aqueous SO-Soil WA-Waste OT-Other ": L-Lifer V-Voa S-Soil Jar 0-Orbo T-Tedlar B-Brass P-Plastic OT-Other <br /> NOTE: Samplpere discarded 60 days after results are repotted unless other arrangements are macro Hazardous samples will be returned to client or disposed of at client expense. The r-nort for the analysis <br /> Of the above: jes is applicable only to those samples received by the laboratory with this cor.. ability of the laboratory is limited to the amount paid for the report. <br />