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Billing Information Alpha Analytical, Inc <br /> NameAft?�& 255 GleMa <br /> venue Suite 21 Page# of . <br /> Address 3 3 G.4wiEIZON f � Sparks 89431-5778 <br /> City,State,Zip r T::7f!� ?iG k Phone (775)355-1044 Analyses Required 08385 , <br /> Fax (775)355 0406 <br /> Phone Number Fax 76-6'�>9.5 D(rr <br /> Client Name �� � 5 PO # Job <br /> Address PWS# DWR# na 1 <br /> City State Zip Phone# Fax# v rp 6a T7-D06(a 8 <br /> • <br /> Office Use Sampled by Repo rt Attention Totaiandtype0 9 <br /> Time Date ✓c N� pw' ! tE'ow ?ko_ <br /> Sampled Sampled See Key Only containers y <br /> Below Lab ID Number Sample Description "See WOW REMARKS <br /> a o f i av aq A�-Q Sig Cul C)0GU G - o I M vv - 5 V <br /> roy5 tooa6 - <br /> 0Z <br /> 04,15 10 0484 —034A VJ -3 5 V <br /> o8e�tease `VA w - `� 5 V <br /> 0 n5 -�� V11 - 5V <br /> 08� -OC.P NAW- � 5V <br /> ►�35 ,aeyla� lea U^7 vV <br /> ADDITIONAL INSTRUCTIONS' <br /> Signature Print Name Company Date Time <br /> 7 <br /> Relinquished by �,.,Gi� �e �'2 !/ �0 U`!-�4r 3 �! <br /> Received by <br /> Relinquished by <br /> Received by -i— -r► a Y l Ey I Q 5 , c <br /> Relinquished by <br /> Received by <br /> 'Key AG-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 /> 1 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 />