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Billing Information: <br /> 1� - Samples Collected From Which State? 61 3 0 9 <br /> S{r`Dy EA.;, Pe _l _l Alpha Analytical, Inc. AZ . CA . NV — WA _ non sire — <br /> Company Name — 255 Glendale Avenue, Suite 2l <br /> Attn: Sparks, Nevada 89431 -5778 ID — OR . OMER — Page # — of <br /> Address 3330 C... Mm P 4. Or , Phone (775) 355.1044 <br /> City, State, Zip <br /> Co^ O. ?ouv CA 56682 FAFax (775) 355-0406 <br /> Phone Number . Fax Analyses Required <br /> Consultant / Client Name Job # Data Validation <br /> Qe. nes Tn..k, ZIS61 - 181 - 0 1 03 <br /> Joo Name Level., ill or IV <br /> Address l8t-r Fm4mo S� 2e�� Report Attention / Project Manager <br /> City, State, Zip ccll `` 1 Name: Ko4 �or.�nee\\ ec <br /> W OGC lUA rA Email: �_ � �� StR�U G+ A EDD/EDF? YES K NO— <br /> Tme Date Matrix' P•O. # Phone: Mobile: `9 W clomt <br /> Sampled Sampled See Key orra ti too PD6o77Dos8.c' <br /> Below Lab ID Number (Use adr) Sample Desc ption TAT Feld d <br /> Fnerre # Contaners" REMARKS <br /> ISys 01/1z Ap AS - 1 3V x x <br /> t; ss f� �+ xwiA ~ DPW - \ <br /> V Mw - Sb <br /> Io zo <br /> 010 <br /> �o a H rnw - 9 <br /> lzz7 <br /> MW - IU <br /> IYoo M4, _ II . <br /> �T ._ <br /> 11 4 <br /> 1r <br /> ADDITIONAL INSTRUCTIONS : <br /> I, (field sampler), attest to the validity ande enti I f this sample. I am aware that tampering with or intentionally mislabeling the sample location, date or time of collection is considered fraud and may be <br /> grounds for legal action. Sampled By: <br /> Relinquished by: (Signature/Affiliation) "� R ce' S ature/Affiliatbnf_ _ <br /> Date <br /> Y ( (�/(IV(/ : Ti e: <br /> c3/1111 03 <br /> Relinquished by; (SignatunvAffiliation) U R ceived b : Si nature/A <br /> Y ( 9 � ) Date Time: <br /> �� <br /> Relinquished by: (Signature/Affiliation) R eived b : Si nature/Affiliation <br /> Y ( 9 ) Date: Time: <br /> 'Key: AQ - Aqueous SO - Soil WA - Waste OT - Other A� - Air ": L-Liter V-Voa S-Soil Jar O-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 laborato with this coc. The liability of the laboratory is limited to the amount paid for the report. <br />