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Billing f rm tion: Alpha Analytical, Inc. <br /> !Name r I�G 255 Glendale Avenue,Suite 21 Page# of <br /> Address Sparks,Nevada 89431-5778 <br /> City,State,Zip ) Phone 1775)355.1044 Analyses Required <br /> Phone Number ax U� by Fax (775]355-0406 Y �I <br /> Ctient Nam P.O.# Job <br /> U <br /> Address PWS# DWR# <br /> City,State,Zip L_ Phone R Fax# 11 \ <br /> Time Date Office Use G Sampledby ! ReporiAtierstion `J1 Total and type of <br /> Sampled Sampled See Key Only lam' ✓ ' containers <br /> Below LablD4 <br /> Number Sample Description See below REMARKS <br /> 00 MIA., <br /> i <br /> ADDITIONAL INSTRUCTIONS: <br /> atu Print Name Company Date Time <br /> Relinquish <br /> Receive <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-Soil Jar O-Orbo T-Tedlar B-Brass P-Plastic OT-Other <br /> NOTE: Sa re discarded 60 days after results are reported unless other arrangements are Hazardous samples will be returned to client or disposed of at client expense. Tort for the analysis <br /> of the ah�vneples is applicable only to those samples received by the laboratory with this cocViability of the laboratory is limited to the amount paid for the report. <br />