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Lab Number <br /> Acculabs Inc. �.� 60 <br /> [ ] 1725 W 17th St Tempe AZ 85281 602-967-1310 Fax 967-1019 <br /> [ ]4455 S Park Ave Tucson AZ 85714 520-807-3801 Fax 807-3803 Report <br /> [ ]2020 W Lone Cactus Dr Phoenix AZ 85027 602-780-4800 Fax 780-7695 Due Date <br /> ( ]2029 N 4th St Flagstaff AZ 86004 520-774-7643 Fax 774-7648 <br /> [vT-1046 Olive Drive Davis CA 95616 530-757-0920 Fax 753-6091 <br /> [ ]75 Suttle St Durango CO 81301 970-247-4220 Fax 247-4227 <br /> [ ]4663 Table Mountain Dr Golden CO 80403 303-277-9514 Fax 277-9512 <br /> [ ]992 Spice Islands Dr Sparks NV 89431 702-355-0202 Fax 355-0817 <br /> Client } li Se21/l'C q! PUBLIC WATER SUPPLY INFORMAfilON <br /> - Y I <br /> Address WCs T .e" fC System Report to State Y N <br /> ' City State b Zip C k ,- D+`/t �'/ & PWS No Report to EPA Y N <br /> Contact k /Y), / w,-A I POE No DWR No <br /> ' Phone 64 1)-1'1 !! Protect Name £,976r4 X 4 k d Collection Point 2t r�6j t kr`vl - ff rc"00 <br /> Fax 614 ail '" �1 1)-0 Protect Number �d S 6 ` /q Collector's Name D� J 11 rd-sf�o <br /> �] <br /> P O Number Fax Results Y N Page of Location(City) -I'[ <br /> SAMPLE TYPE CODES e 3 ' Or _ -1 Analyses <br /> DW=drinking water TB=travel blank Compliance _- Requested <br /> waste water SD=solid Monitoring n <br /> !MD-'monitonng well SO=soil Y N p t <br /> HW=hazardous waste SL=sludge I a `- <br /> �fi TURNAROUND TIME REQUESTED <br /> n <br /> ttndad,, Lab Manager <br /> Approval F- <br /> SH <br /> `1 <br /> R - y r x <br /> T'S SAMPLE'll]1LOCATION ©ate' Time Spl No <br /> S a>✓ 0 9 y 1 Ir 3 x tI <br /> P y <br /> Uf `l� 1r I`/� !s <br /> Instructions/Comments/Special Requirements <br /> 1 � _ A-smle+sa R<eeCe vSAMPLERECEIP' T, Date Time Sarp_eS R@lingtis,t <br /> Received Cold Y N <br /> Custody Seats Y N <br /> sass Intact Y N <br /> J <br /> No of Containers 5 _ <br /> n s f q. yt k °.� J17" <br /> 'R 5 E ., ,� �W �. <br /> Acc€�labs terms are aNet 4Q (Payment=must"be received by;the date`shoWn on the invoice or any discount is rrord)—, W <br />