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Billing Inform on Alpha AStical, Inc ` <br /> Name I— /�/ v <br /> 255 Glenda! nue Suite 21 111, Page# { of <br /> Address C BVI 0/L_ Sparks,Nevada 89431 ` <br /> City,State,Zip -y Phone (702)355 1044 <br /> Phone Number F6 - Fax Fax (702)355 0406 Analyses Required <br /> Client Name <br /> RE <br /> PO # <br /> 1 Job <br /> Address �^y <br /> Q�C./ ' �o ev T ` PWS# DWFt# <br /> City State Zip r P� r f <br /> r'06 ^ I G y� Phone# Fax# �' r <br /> lJ V r L✓ � <br /> Time Date Wtax Office Use Sampled by f-y ReportAttenuon 1i <br /> C j7 T J�I f U otal and type of ki �c <br /> Sampled Sampled See Key Only containers <br /> below LablDNumber Sample Description .�SeeDelarr '� REMARKS <br /> to:o ��.,,, vao5a U-o <br /> �µs <br /> r <br /> ellR." <br /> a I� �Q� lIV '•-- f � <br /> `0� <br /> l0' <br /> _/0 to <br /> r <br /> ADDITIONAL. INSTRUCTIONS <br /> Signature Print Name Company tate Time <br /> Relinquished by <br /> p <br /> Received by , <br /> c <br /> Relinquished by � <br /> Received by f 2 <br /> Relrnqurshe b r e L-� ✓� y <br /> I Received by <br /> 'Key AQ-Aqueous SO-Soil WA-Waste OT-Other "' L Liter V Voa S Sol!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 abe a samples Is applicable only to chose samples received by the laboratory with this coc The liability of the laboratory is limited to the amount pard for the report <br />