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uIkl"hy 'ti' +"ua"u".. Alpha Analytical, Inc. oamples Voliected From Which State? <br /> Name f° a` s �'7JcdoM v� l AZ, CA V NV WA <br /> 255 Gler�venue,Suite 21 tp OR i OTHER j—of_I ` <br /> Address 33 ,,,-e rson #oe- '0". s�.7- v Sparks, a 89431-5778 <br /> City, State,Zip Ga-•+- a rv^ O..i K e_ . RSL g Phone (775)355-1044 <br /> Phone Number 174,7GGaoY Fax S3-0 A P-40 or Fax (775)355-0406 Analyses Required 73 %J <br /> Client Name ,� P.O.# Jab# <br /> LA S 14 5 ;!,o or-d s d ,� Required QC Level? <br /> Address EMaii Address �J,4 l � � <br /> City,State,Zip Phone# Fax# IV <br /> G <br /> � EAD/EDF?YES_�NO <br /> Time Date Matrix` Office Use Samd b R&Allention' To#al and <br /> Only ,(/ I a-. o� vw r rarte. type of o To <br /> Sampled Sampled See Key y conIainers crob�rrnM�p77adoL <br /> Below Lab ID Number Sample Description TAT rr�ered "see below �� �� REMARKS <br /> a cQ) ii o (A u s)q 6 S' /¢ 1..,,jr S I T <br /> x x <br /> o&Fr _O ks *&s J4 S -,.ice S <br /> r <br /> a7r�� L'5 '04.5 J4 r-1c'e <br /> I <br /> ADDITIONAL INSTRUCTIONS: <br /> Sign r Print Name Company Date Time <br /> Relinquish b ./ d G y� <br /> f� �`""� G� !fs � YG�. ! c+. S t f✓t V �4 O G/� <br /> Received by <br /> ,:/lam. �,:,�i3✓�,..� �j�,f��, iz�5- <br /> Relinquished by <br /> Re ived'by <br /> Relinquished by <br /> Received by <br /> `Key: AQ-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 /> 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 />