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Name' 'nrormawn — Alpha A tical, Inc <br /> 255 Glend nue,Suite 21 Page #__-_L_of �t " <br /> Address D� Sparks,Neva 88431-5778 ' <br /> City,State, p � CQ, Phone (775)355 1044 L - <br /> Phone Num 7 ODY Fa b G G. (po$ Fax (775)355-0406 Analyses Required A ' <br /> Client Name PO # <br /> Address t PWS# C � ���O�Za� <br /> v44- <br /> City 51ate Zip � Phone# Fax# <br /> Time Date • Office Use sampledp�� / Rsepry,p3tentipp , <br /> Y"� ` {".'1C�cst C..+ Total and 3ype of � <br /> Sampled Sampled See Key only containers 0 <br /> Below Lab ID Number SampleDescnption "Seebe#ow !~ REMARKS <br /> D3M Q1 do <br /> ADDITIONAL INSTRUCTIONS <br /> Signature Print Name Company Date Time <br /> R ed by / 5f GQ 01 toeece edb y <br /> lnGfMA � r�Givtd 5 a3 0,11 b <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 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 /> :f 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 />