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Stlhng f rma ton l <br /> Name �, G Alpha A tical, Inc <br /> �—� 255 Glendal nue,Suite 21 ��7 <br /> Address %� �� E f Page (# of <br /> °` r- Sparks,Nevada 89431 5778 <br /> City,State,Zip Phone (775)355 1044 <br /> Phone Number �x iPax ! P t�`r` � AA Fax (775)355 0406 Analyses Required <br /> Client Name /I <br /> it <br /> c l PO a Jo r�tJ <br /> Address I PWS u � <br /> DWRH <br /> City Slate LP Fax fJ <br /> Time Date Matax' Office Use li Sampled by !� {�` neport Altenlx7n Tolal and lype of +� <br /> Sampled Sampled See Key y J ! �,� t ` <br /> Below Lab ID Number Sample Description containers <br /> 102Z _ ° See bel°w REMARKS <br /> "J l✓ J � Ibvt <br /> ✓ t� <br /> 4 <br /> it <br /> �i <br /> 1 <br /> ,I <br /> II <br /> r <br /> ADDITIONAL INSTRUCTIONS <br /> i <br /> S ur Print Name <br /> Relinqulsttedby W! Company bate Time <br /> Receivectb <br /> Relinquishedby ! __ <br /> Received b <br /> y � i� if •- w 'I �`--- ; �_ 1 �( _t'4 \' t- i : �.��` t,. t i � 5'_.k� ' � r � ` e <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 Sarnples are discarded GO days atter 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 /> 11 <br />