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Billing Information: — Alpha jWlyfical, Inc. <br /> Name 255 Glen venue,Suite 21 Page# 1—_of <br /> Address Sparks, Ne"d a 89431-5778 <br /> City, State,Zip I? � CiY7 s Phone (775)355-1044 <br /> Phone Num i Fax Fax (775)355-0406 Analyses Required <br /> Ciiegt Nr <br /> me C P.D.# Job Af <br /> Address J PWS# DWR <br /> City,Stat Zip Phone# Fax# (L ���'77a;o6 <br /> 6 r \' <br /> Time Date %tafie Office Use 5a�lp}Q��y/7 _ Repo ention r Totalandlypeot <br /> Sampled Sampled See Key Only containers REMARKS <br /> Lab 10 Number Sample Description "See below ` ` <br /> I L, <br /> ADDITIONAL. INSTRUCTIONS: <br /> Signature Print Name Company //Date` Time <br /> ed by <br /> Rece ed {j t r9t'I ✓'r J, <br /> f 1 <br /> Retinquishe y I; <br /> f,r I <br /> I4 elinpuished by h <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: 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 laboratory with this coc. The liability of the laboratory is limited to the amount paid for the report. <br />