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aampies tia[Jecrea from Which State? <br /> Billing Information, Alpha Analytical, Inc. AZ_ CA X NV WA <br /> Name r G ID OR OTHER ot� ` <br /> 255 Gle venue,Suite 2t <br /> Address T....er.,c IPY LOL dw r� rrD Sparks, a 89431-5778 <br /> City,State,Zip Ct,„d�..� �•"vKy G4Pho4b�6$Z Fax (775)7757355 04-7644 Analyses Required 7359 <br /> Phone Numb rL—Good Fax ne""_"; ( } <br /> Client Name P.O.# Job k Required QC Level? <br /> u5 A 6S onT-avis of <br /> Address Entail Address �!� �1 !! !V <br /> City,State,Zip Phone# Fax a V <br /> P A EUD I EDF?YES NO— <br /> C <br /> Time Date Matrix' Office Use Sam d b�c. R d Attention Total and type of x Turco 771�AD <br /> See Key Y . Ya A.� O.d r r Ko.J/tea.. ` G+obslrP r <br /> Sampled Sampled Only Field containers f 9 <br /> Below Lab ID Number Sample Description TAT F,uered "See below �. '�3 REMARKS <br /> Iyu,n tr# T <br /> I <br /> 1 t <br /> i <br /> ADDITIONAL INSTRUCTIONS: <br /> i <br /> Signature Print Name Company Date Time <br /> W. <br /> j <br /> Relinquished y �O tG -�JA,0( 6r✓-whys Wirt ✓ ��t D 6 (S <br /> Received by 34J <br /> [v <br /> Relinquished <br /> Received b <br /> Relinquished by <br /> Received by <br /> f <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: 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 />