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Billing Information: �na ) ytic Alpha Analytical, Inc. <br /> Company. Broadbenl ,C? a' i Main Laboratory- 255 Glendale Ave, Suite 21 Sparks, NV 89431 Phone: 775-355-1044 <br /> Alin: TM sabeock �� ? Fax: 775.355.0406 <br /> Address: 1370 Ridgewood on". Surto 5 j Satellite Service Centers: <br /> city, State, Zip: CNw, Caldernia 95973 t Northern CA: 9891 Horn Road, Suite C. Rancho Cordova, CA 95827 Phone: 916.366-9089 <br /> Phone Number. 530-566-1400 Fax: <br /> ��O�menta� Nonhem NV: 350 7th St, Elko, NV 89801 Phone: 775-388-7043 Page # of <br /> Consultant/ Client Info: Job and Purchase Order Info: Report Attention/Project Manager: QAC Deliverable Info: <br /> Company: Brwdbont Job 0 19.08.161 Name: Tun Babcock EDD Required✓ es No EDF Required? Yrs / No <br /> Address: 1370 Ridgewood Dove, Sune 5 Job Name: Pilot Flying J e618 UST Ramoval Email Address: tbolv'.xk" hrnndh"nenr. nam <br /> City, Slate, Zp: Chico. Califomia 95973 P.O. a: Phone #: 530.566-1400 <br /> Global ID: <br /> Cell #: 530-5t3-w68 Data Validation Packages: Ill or IV <br /> Samples Collected from which State? (circle one) AR CA\ KS NV OR WA DOD Site Other <br /> Analysis Requested Remarks <br /> < :E <br /> 2 p o L) N <br /> } 00 03 © F <br /> m 03 <br /> m <br /> O N m L) N w O W <br /> LL O <br /> Time Date Atatrbr• LL H N 0 cn O a <br /> Sampled Sampled (Soo Key U <br /> HHfAMI IM6yDD Below) Lab ID Number For Lab Use Only) Sample Description TAT Yes No <br /> � 00 P- 1 ar�,Y `� a x x X 2C x <br /> f_ .7D - t UZ - i. a. X >C X x x <br /> S 1 t m 5 D3 : Y% x >C oe X X <br /> 106 <br /> L' I 7�' <br /> I <br /> ADDITIONAL INSTRUCTIONS: <br /> 5 >�. Sri �� u � � � • I <br /> ry Cc aJ- l I J a <br /> / <br /> I (field sampler) attest to the validity and authenticity of this sample(s). 1 am award that tampering with or intentionally mislabeling the samplo location, date or time of collection is considered fraud and may be grounds for legal action. NAC 445.0636 (c) (2). <br /> Samp B <br /> Reil b : (Sign re/Alldi 'on): Dale: Time: Rece d by: (S na ure/Alllliation): Dare: Time: <br /> 3 z � 1a � 3 � z� z <br /> Relinq i ed by. (Signa boat Date: Time: Received by: (Slgnalure/Alhliation): Date: Time: <br /> Relinq <br /> (fa 2D 5 <br /> i ed by'. (Signature/Agillation): Date: Time: Received by. (Slgnature/Albtial n): Dale: - Time: <br /> Ker. AQ - Aqueous AR-Air OT - Other SO - Soil WA-Waste B - Brass L - Liter O - Orbo OT-Other P-Plastic S-Soil Jar T - Tedlar V-VOA <br /> NOTE: Samples are discarded 60 days atter sample receipt unless other arrangements are made. Hazardous samples will be returned to ebenl or disposed of at client expense. The report for the analysis of the above samples is applicable only to Those samples <br /> received by the laboratory with this COC. The liability of the laboratory is limited to the amount paid for the report. <br />