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Billing Inform � Alpha An• ai, Inc <br /> w <br /> Name <br /> AddresJ''� r s~ 255 Glendale Aiee StiNe 21 <br /> `"'~ � Sparks Nevada 89431-5770 Page # of <br /> city,State,zipa r�z _ Phone (775)355 1044 <br /> Phone Number' �' Z'� Fax f �rl�C✓J Fax (775)355 0406 Analyses n('qurred <br /> Client Name PO li Job N <br /> AddressJ� <br /> PWS X <br /> -II, Zip p i Phone N <br /> f Fax k , <br /> -iz <br /> Time Date w 11:e Use samplrtlby .! // ReporlAllenlwn �� r <br /> See Ke Only / !c ✓L /[ f Total and type of <br /> Sampled Sampled y ) <br /> Below Lab ID Numbercontainers <br /> Sample Descriplron <br /> on below 1 <br /> 1 <br /> * ! J� � { q _ REMARKS <br /> Cog G�� GJ ! >I (t )r ��r y�� �C t <br /> A- <br /> f 'l <br /> I, <br /> �E <br /> ail <br /> 1 <br /> 1 <br /> ADDADD�AL INSTRUCTIONS <br /> �l <br /> Sig r F6, Print Name Company Date Time <br />� Rellnqulshe <br /> Receive y <br /> Relinquished by <br /> Received by <br /> ��+ _ •�_*� ,� iii.! }�Y 't—ff� l� tf � f E�i�ti�Ci�,.._ f I � r�E� r + � <br /> Retmqucstled by t- <br /> li <br /> Received by <br /> Key AQ-Aqueous SO-SO)] WA Waste OT 01her L Lder V-Voa S Soil Jar 0 Orbo T-Tedlar 4-Brass P-Plastic OT Other <br /> NOTE Samples are discarded 60 days nafter results are reported unless other arrangements are made I Iazardous 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 laboralery with this ror This hahrtity of ihp lahnrarnn.,� <br /> I' <br />