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umni4 ttiiurmation Alpha Analytical, Inc r <br /> Name = '� �� ;r `1uYU 121L• 255 Glend nue,Suite 21 0328 <br /> Address ��*� r c L p�L Sparks Nev 89431-5778 Rage# of 7 <br /> City,Stale,Zip Pyrone (775)355 1044 <br /> Phone Number=' �� '7 lam`/ Fax s 14 ) Fax (775)355 0446 Analyses Required <br /> Client Name PO # #Job <br /> Job <br /> Address PWS q DWA q <br /> City State Zip Phone 4 Fax p GCS ;7 7,,0 Z � <br /> Time Date fyla�c' Office Sampl i �. ! RepertAtten! Tataland typeof Wyk <br /> Sampled Sampled See Key y rr`L' � �Ir [ containers <br /> Below Lab ID Number Sample Description "'See below REMARKS <br /> b V ti � <br /> ADDITIONAL INSTRUCTIONS <br /> Signature ]�{ ' Print Name Company Date Time <br /> 7RReCelNn ed by � <br /> d by - -- <br /> Relinquished by <br /> Received by . <br /> iiA <br /> Relinquished by <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 analysts <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 />