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Samples Collected From Which State? <br /> 0 <br /> Billing Information:_ Alpha Analytical, Inc. AZ_ CAA-_ NV_ WA <br /> !Name 0 rr.w A49.,is f 255 Glendale Avenue,Suite 21 ID OR— OTHER Page q_L_of L <br /> Addressjj +..moo.+ I r. ✓�.,7e o Sparks,Nevada 89431-5778 <br /> <«s fie 1 p� y sc J Phone {775}355-1044 Analyses Required 0 9 6 7 3 <br /> City,State,Zip 4 Fax (775)355-0406 Y <br /> Phone Number,f: 47L–leoY Fax °67L–Ga°J <br /> Client Name P.O.# Job# Required OC Level? <br /> U.S1'4 L 3 .ZO67-o��r o f � <br /> Address EMail Address li4 v! ff fl! !Y <br /> City,State,Zip Phone# Fax# EDDJEDF?YES K NO_ <br /> LssQr <br /> Matrix. Office Use Sam leq,py Re ortanentiori,�J it Total and type of �`� )it Wobaf fD#70 O <br /> Time Date Only ���^ '�" 1C containers f <br /> Sampled Sampled SeeKey REMARKS <br /> Below Lab Ib Number Sample Description TAT Erre� "See below <br /> f 2tD 19i5 Q I' 6AS JQL S4 Z. IC I T X <br /> 1 rS uts �4t5 A' sT.+� <br /> tzfyy S'��oS�to'7of — use! is �YJi..i Ar <br /> I <br /> Ll <br /> ADDITIONAL INSTRUCTIONS: <br /> j Sign Print Name Company Date Time <br /> Relinqu' db `~ r y���Q� ZO <br /> wok ay r.l�.•r S'Tic7ks t-•d• <br /> Received <br /> Retinquished by <br /> Received by f' 1 17 t <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 liabilsty of the laboratory is limited to the amount paid for the report. <br />