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Billing 1 8t n ., Samples Coll ted From Which State'7°�,f, �/` Alphalytical, Inc. AZ� CAS nrv_ WA <br /> Name 255 Gle Avenue Suite 21 1p OA OTHER llf�al <br /> Address Sparks Nevada 89431-5778 <br /> City State ZipPhone (775)355-1044 <br /> PhoneNumber tax 3 [�iGC Fax (775)355-0406 Analyses Required 0 4 <br /> Client Name ��� PO # ,fpb# <br /> r 4 Required OC Level <br /> Address EMad Address l <br /> J�1 r It It/ IV <br /> City,State Zip Phone# <br /> 1 0� ! l Fax# <br /> lam+ L EDD l EDF?YESX NO <br /> Time Date Matrix CNice Use Sarrpied b /yt L Aepo t At1en Total and type of <br /> Sampled Sampled See Key <br /> Only J �`� ; containers Gror�ar rd 7 L�aN <br /> Below Lab ID Number Sample escri tion TAT Field REMARKS <br /> ,ter /_ P P FrPrered See Below <br /> PV <br /> ADDITIONAL INSTRU ONS• <br /> S a eI Pnnt Name Company Date Time <br /> Relinquts by <br /> Receiv <br /> Reltnquished by <br /> Received by _ S r - I v S Y 00 <br /> Relinquished by s}-1/ a [ <br /> Received by <br /> `Key AO-Aqueous SO-Soil WA-Waste OT-Other "' L Liter V-Voa S-Soil Jar O-Orbo T Tedtar 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 reoort <br />