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Bi"ll"glnfor on 'Alpha tical, Inc <br /> 7Vame �i1 °' n 255 Glennue,Suite 21 Page# of 1 <br /> Address 33]O C�3� �� 1 ,-rt /C_ E> Sparks,Neva a 89431-5778 <br /> City,State, ip ��`�� ���� �G Phone (775)355-1044 <br /> Phone N — Fax Fax (775)355 0406 Analyses Requiredi . Al <br /> L �` <br /> Ciient Name / 1 PO # Job# <br /> /-1�1 " S-1'? �,� CC f '2r-c <br /> Address PWS# DWri# � <br /> J <br /> City State Zip Phone# Fax# 1 i'1 << <br /> Time Date Office <br /> Use Sampletlby,/��� RepohAttenFiory� 2 Totalandfypeof Qk <br /> Sampled Sampled See Key r7 containers iJ 1 <br /> Below kablDNumber Sample Description "Sabdow — REMARKS <br /> f5A_' 12 <br /> 6L Z 5 <br /> <// <br /> I/5z 11�1tJ <br /> 5 <br /> L4c3� t�lw y S <br /> "} fV11'J-I0 <br /> b,oy IM4J 1 1 -� \ <br /> i <br /> I <br /> ADDITIONAL INSTRUCTIONS <br /> Signature Print Name Company Date Time <br /> R ed by _ <br /> r l LILGC/� ��w�V/ � C't[ � tel/ IZ l t 0�tio <br /> R ved by <br /> A; 02 Q6)u-0 <br /> Relinquished by <br /> Received by <br /> Relinquished by <br /> Received by <br /> 'Key AQ-Aqueous SO-Soil WA-Waste OT-Other L Liter V-Voa S-Sod Jar 0-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 />