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Samples Collected from Which State? <br /> Name <br /> • <br /> Billing [n tion: �- Alpha ytical, Inc, AZ CA NV_ WA <br /> r p t w a C.a J.�.r�w�.l.��� <br /> 255 Glendale Avenue,Suite 21 !D OR OTHER Page#___of_-___ <br /> Address 333 0 Gs+.a &-A- PSC /,1r, da--It r;'� AA Sparks.Nevada 89431-5778 • <br /> City,State,Zip Ge. -0eQ.ti PIC-. C-- �� Phone (775)355-1044 <br /> Phone Number(00 476-400q Fax%00 d 74C-"TE Fax (775)355.0406 Analyses Required rl ; 6 <br /> . v <br /> Client Name P.O. Job x <br /> U Jr t S oe f-^oe�f o / Required QC Leve!? <br /> Address Entail Address <br /> 1! 11! 1V <br /> City,State,Zip Phone p Fax M Q7 <br /> L�O A/ C Y EDD/EDF?YES�[ NO— <br /> Time Date Matrix' O ce Use Sante bye R o t Attention �y Tota4 and type of Z� x <br /> fit/ r0 !�"� OQO// �.,-/..�•'L4 Global lblT !O7 IOPi <br /> Sampled Sampled See Key Only Frew cordainers 1_ <br /> Below Lab 10 Number Sample Description TAT weed "Sea below REMARKS <br /> 0 Ice, yr us R tsA Xp.4 s t T y X <br /> Ono fk� a s iK" S <br /> e4Ys tt s A L s R 49�r'r 2 Y it, I't <br /> I _ <br /> i <br /> I <br /> ADDITIONAL INSTRUCTIONS: <br /> Signature Print Name Company Date Time <br /> Relinquished by ieir.r� (,� rr�s-► .� rS!�s f.mss C.s �J. p <br /> Received by <br /> Relinquished by f <br /> Received by <br /> Ra�i�quished b- <br /> i <br /> Received by <br /> 'Key: AO-Aqueous SO-Soil WA-Waste OT•Other ": L-Liter V-Voa S-Soil Jar O.Orbo T-Tediar 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 />