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Billing Info on: Alpha flytical, Inc. <br /> 255 GlendWvenue,Suite 21 <br /> Address C ��is�^-J '1� Sparks,Nevada 89431-5778 Page# of <br /> ✓ i to Phone (775)355-1044 <br /> City,State,Zip +F <br /> Fax (775)355-0406 Analyses Required F5 } <br /> Phone Num Flo rAx C..tsm / Fax G-7�- � <br /> Client Name P.O.q Job# <br /> Address PWS 0 DWR q 1{ S <br /> City,Stat Zi6 Phone# Fax <br /> L ai <br /> 1: Afiatrtx* Office Use Sampled Rep ort Attention , <br /> Time Date /�L (� ` Total and type of <br /> Sampled Sampled See Key Only containers <br /> Below Lab IDNumber Sample Description *'See below `'1 REMARKS <br /> '? M C <br /> I <br /> 1 <br /> k j <br /> 1 <br /> I � <br /> I <br /> I <br /> ADDITIONAL INSTRUCTIONS: <br /> Signature Print Name Company Date Time <br /> Ref hetl � !� ,mow t/ s y �, r✓ I& <br /> Receiv by <br /> I Relinquishedby <br /> Received by <br /> Relinquished by <br /> Received by <br /> it <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-Othef <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 /> i 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 />