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ACCulabs Inc. Lab Number Lm <br /> [ <br /> 11722 <br /> 5 W 17th St Tempe AZ 85281 602-967-1310 Fax 967-1019 <br /> ( ]4455 S Park Ave Tucson AZ 85714 520$07-3801 Fax 807-3803 Report <br /> ( ]2020 W Lone Cactus Dr Phoenix AZ 85027 602-780-4800 Fax 780-7695 Due Date <br /> [ ]2 29 N 4th St Flagstaff AZ 86004 520-774-7643 Fax 774-7648 <br />' [ 1046 Olive Drive Davis CA 95616 530-757-0920 Fax 753-6091 <br /> [ j 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 /> .� <br /> d' Yq& T10NSPhfb WAW§JFLNF <br /> Client Pf i Yr1f(/icef <br /> Address a/o � <br /> System Report to State Y N <br /> ' City State&Zip D( K zv1 4,IAJG , PWS No Report to EPA Y N <br /> Contact M;I Lt! /I L, POE No DWR No <br /> ' Phone /Y � f` �� �� Protect Name e.49,7 6,W,-' Gif Collection Point £,SAA w 7-oc k-6 <br /> N <br /> Fax I q 01 J Id-0 Protect Number �� Collector* Ds Name I/. V e'll'Orre <br /> P O Number Fax Results N Page of L - <br /> ocation (City] STpG C.-. <br /> v ` - �SAMPLE TYPE CODES' Analyses <br /> DW=drinking water TB=travel blank Compliance ,C Requested <br /> =waste water SD=solid Monitoring ,,— &-&' a <br /> k <br /> W monitoring well SO=sol[ Y N <br /> HW=hazardous waste SL=sludge <br /> TURNAROUND TIMEAEQUESTE©3 �z'` � e �� I X <br /> ,,n , <br /> t1GRUSH <br /> tab Manager `-eApprovalr"'f- <br /> Fp <br /> ecuaitb <br /> r ,� a ami,..*�.wd.a€ a:%, = ,�; -max; <br /> GL[ENtS:6AMPLE IDlLOCATI4N�,� Date Time< � s 5pl No <br /> I�ctrp 0�l Y 19 f� Ian f- 4104 � � <br /> M W-0 I of' r Y ! /6=a-r Y a3 <br /> Ir <br /> of' IV f 9 f/ ry oy��a as <br /> sal 3 0 fr If 1 �9 /f{!Yo X- 0� <br /> SPoI Orrr f/ly Id' y yC v� <br /> It sP ea- of- r�- I F�Iy lJ�.a� If � Olt <br /> Pz� of 0y or f �Y y: 01 >C- X- <br /> InstructionsfComments/Special Requirements <br /> -•«t�`3s`��*rtshed:�S'>�, <br /> SAMPLE�RECEIPT� � Date Time Samples�Rehr�quB i, Samples�Re elvedlBy °, <br /> Received Cold Y N �-to <br /> ustody Seals Y N <br /> eals Intact Y N <br /> No of Containers b <br /> Acculabs'terms are ;Net 40„(Payment°must be,recelved by�the dateFshown on,the Invoice°oreany disco nuts void) <br /> '>� <br />