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Whin Information Alpha Iytical, Inc <br /> Name Willing <br /> Nt! y <br /> t 255 Gler,Jven43 Suite 21 Page# 1 of <br /> Address � ��-r''�t �= ��� Sparks,Ne ada 89431 5778 Pa <br /> City,State,Zip L C Phone (775)355-1044 y <br /> Phone Number-�6JKC6C' Fax�LZ1426-CCCFax (775)355-0406 Analyses 0equred (� <br /> Client Name P O # Job# fN Id. <br /> fL 572 I`� S i , <br /> address PWS# DWR# <br /> VJ7-L }' <br /> ity state Zip Phone# Fax <br /> Time Date Office <br /> ttOntUse Sampled by f I Repor�ttenUon Totaf and <br /> ,Q ' r, typeaf <br /> Sampled Sampled See Key y containers �t V <br /> Below LabIDNumber SampleDescnption ••Seebelaw "` (� REMARKS <br /> 7610 � 1f`` ''l" flit <br /> { <br /> 1 r <br /> e f <br /> r <br /> f r ` <br /> t-`- <br /> i <br /> an.t e_� �, k J rt <br /> ADDITIONAL INSTRUCTIONS <br /> Signature Print Name Company Date Time <br /> 5:`]"fZ-6f.L "�—t_ - <br /> Re ived ErrIL <br /> jjrr 4 j ry �� f <br /> Relinquisfiea Pv <br /> Received by <br /> Relinquished by <br /> Received by <br /> 'Key AQ-Aqueous SO-Soil WA Waste OT-Other L Liter V Voa S Sod Jar 0 Oft T-Tedlar B-Brass P Plastic OT Other <br /> !VOTE 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 cheat 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 />