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Billing Information : Sart{�las Collected From Which State? <br /> 9 Alpha Analytical , Inc. AZ _ A Nv _ WA _ <br /> Name 255 Glendale Avenue, Suite 21 <br /> IDOR _ OTHER Page # of <br /> Address Sparks, Nevada 89431 -5778 <br /> City, State. "-- Phone (775) 355-1044 All <br /> Phone Nui <br /> PRIMA ENVIRONMENTAL _ Fax (775) 355-0406 Analyses Required 1 1 8 8 6 <br /> Cram Nan 10265 Old Placerville Rd, Ste 15 P.o. # Job ' Required OC Level? <br /> Sacramento, CA 95827-3042 � — <br /> Address EMail Atldree (( I 11 III IV <br /> PH : 916-363-8798 C e,�e 1 . Q <br /> city, state FAX: 916-363-8829 Phone # Fax # <br /> EDD/EDF? YES NO <br /> — <br /> Tons <br /> Date Matrix' Office Use 5 p by port Al ntio Total and type of <br /> W. crobl rD x <br /> Sampled See Key Only r-e,1e. r F1erd containersBelow Lab ID Number Sample Desc iption '. TAT F;irered " See below REMARKS <br /> CR L5 t vIx1666 >ni Lx So <br /> VIL Iba6 Z — B <br /> b le <br /> YF <br /> - — e <br /> _ I <br /> x <br /> �DITIONAL INSTRUCTIONS : <br /> 6 Act njj o A) a <br /> ignature Print Name Company pp ��tt Date Time Time <br /> Received by , LPA) <br /> W G� �� 0� ` L� QrD J <br /> Relinquisha y <br /> Recall d by U� I W4 nnI-- / 7Z' <br /> �.' , � 1 V 1 <br /> Relinqui ed by �Yil <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 />