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-""•5.••• •. •1 V1 i. <br /> Name r°', [- Is'L., Alph Analytical, Inc. , <br /> Address L.`y > 255 le Avenue,Suite 21 <br /> �si4 ✓I 'LL `- Sparks,Nevada 89431-5778 Page #__. _.__of <br /> City,Slate,zip �. ;-t •; r, y Phone (775)355-1044 <br /> Phone Number _ i' LL Faxr' Fax (775)355-0406 Analyses Required <br /> Client Name / { <br /> ! /'�' P�•# Job# <br /> Address -- M <br /> PWS# OWR# x <br /> I v` <br /> City,State,Zip i — j <br /> ' / Phone# Fax# <br /> jTimeDate Mall x* Office Use SampledG� L— enonTotalantled See KeyOnty %% typed€ <br /> Below Lab ID Number containers <br /> Sample Description See belowREMARKS <br /> 1 <br /> ADDITIONAL. INSTRUCTIONS: <br /> S' tilr Print Name <br /> ROnqui d by'`/ ! Company Date Time <br /> Rem <br /> Relinquished by FE; <br /> Received by <br /> Relinquished by <br /> Received by <br /> 'Key: AQ-Aqueous SO-Soil WA-Waste OT-Other <br /> ": L-Liter V-VOa S-Soil Jar O-Orbo T-Tedlar B-Brass P-Plastic OT-Other <br /> NOTE: Sampies 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 />