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Samples Collected From Which State? l <br /> Billing Information : Alpha Analytical , Inc. AZ _ CA NV WA <br /> Name 255 Glendale Avenue, Suite 21 <br /> f. <br /> Address Sparks, Nevada 89431 -5778 ID _ OR OTHER Page o <br /> City, State, 71_ Phone (775) 355-1044 <br /> Phone Nun PRIMA ENVIRONMENTAL _ Fax (775) 355-0406 Analyses Required 11885 <br /> orient Nam 10265 Old Placerville Rd, Ste 15 P.O, a Jot, u <br /> Required QC Level? <br /> Address Sacramento, CA 95827-3042 ENa;lAddress <br /> PH : 916-363-8798 + 2 I If III Iv <br /> city, State, FAX: 916-363-8829 Phone a Fax a <br /> ///fflj IGICMID #� <br /> DIEDF? YES_ ND _ <br /> Matrix' Office Use Sam b portAt� tion Total and <br /> Time Date Only IhC.n S e e type of <br /> Sampled Sampled See Key y Rem containers <br /> Below Lab ID Number Sample Des ription TAT Rlre,y •' See below If REMARKS <br /> not I . o 2-:7 • G =res <br /> S <br /> e <br /> LD <br /> _O g <br /> ADDITIONAL INSTRUCTIONS: <br /> Si ature rint Name Company Date Time <br /> Relinquislb 77 <br /> PAA r ) 3:00 <br /> Received by U <br /> 0 1 .100 <br /> Relinquished by s(fl <br /> -ct"tAoik ( Z <br /> by <br /> Relingm y <br /> Received by <br /> `Key: AQ - Aqueous SO - Soil WA • Waste OT - Other L-Liter V-Voa S-Soil 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 />