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samples Collected From Which State? <br /> Billing 1 m tion: Alpha Analytical, Inc. AZ_ CA_ Nv_ WA <br /> 'rl JZ <br /> Name Ile <br /> 255 Glendale Avenue,Suite 21 10 OR— OTHER # of <br /> Address 4 Sparks,Nevada 89431-5778 <br /> City,State,Zip $' At Phone (775)355-1044 V) 15694 <br /> Phone Number " ' Fax !33-, lL-L-02-5 Fax (775)355-0406 Analyse$ FI¢quired <br /> Cl' Na a P.O.# Job# c�j <br /> ?_ 'tel -L'i Required OC Level? <br /> Address EntI If III IV"44 Ci rtAail Address =°� v <br /> City.State,Zip Phone# Fax# ` <br /> (SOA EDD/EDF?YES_ NO <br /> Time Date Matrix- d by L'� Report Attention Total and type of `� Q: ` �a Gfobgd e s <br /> Sampled Sampled See Key 7 � F Mainers r v 3 <br /> Below Lab ID Number ( u5B On ) Sample Description TAT Fwew "See below REMARKS <br /> !! 05 17 5L) -7os232o -ot F l-2 I- ✓ _ <br /> 45 so Oz � <br /> - <br /> �- 1-sem t <br /> 16 - 03r Air <br /> �L� ► ✓ a. <br /> (0S—q'50 by -,I V —.5 vri <br /> !i0` <br /> A <br /> 1 <br /> i? 2 <br /> c <br /> ADDITIONAL INSTRUCTIONS: <br /> .§ign9jure, Print Name Company Date Time <br /> Relinquished by <br /> Received by <br /> Relinquished b <br /> Received by f5 <br /> Q 20 <br /> Relinquished by <br /> Received by <br /> 'Key: AQ-Aqueous SO-Soil WA-Waste OT-Other AR-Air "': L-liter V-Voa S-Soil Jar 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 />