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ACculabs Inc. Lab Number <br /> [ ] 1725 W 17th St Tempe AZ 85281 602 967 1310 Fax 967-1019 <br /> [ ]4455 S Paris Ave Tucson AZ 85714 520-807 3801 Fax 807-3803 Report �j <br /> j J 2020 W Lone Cactus Dr Phoenix AZ 85027 602-780-4800 Fax 780-7695 Due Date I [ - C <br /> 01029 N 4th St Flagstaff AZ 86004 520 774 7643 Fax 774-7648 <br /> F 046 Olive Drive Davis CA 95616 530 757 0920 Fax 753-6091 <br /> [ ] 75 Suttle St Durango CO 81301 970-241 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 7C2-355-0202 Fax 355-0817 <br /> CIient a T G r pr j PUBLIC WATER SUPPLY INFORMATION <br /> Address �75� q <br /> T ✓lr+ [ r S7 e- System Report to State Y N <br /> City State&Zip 14Apr rr i,nom T J PWS No Report to FPA Y N <br /> Contact p ) / POE No DWR No <br /> ' Phone t � � C+ -3419 0 Project Name 54L{ Collection Point <br /> Fax Z7 -3 -1-<, -39 i project Number Collectors Name <br /> P O Number Fax Results Y N Page of Locatton (City) <br /> SAMPLE TYPE CODES Analyses <br /> DW =drinking water TB=travel blank Compliance S C Requested J <br /> a o vn <br /> WW -waste water SD =solid Monitoring m n vat <br /> ' MW- monitoring well 3soil Y N p t <br /> HW - hazardous waste SL=sludge f a <br /> TURNAROUND TIME REQUESTED e i <br /> 1 n <br /> Standard Lab Manager <br /> ftUSFf Approval y r <br /> Special p s <br /> e � <br /> CLIENT'S SAMPLE IDILOCATION Date Time spl No <br /> Mw <br /> i <br /> instructions/Comments/Special Requirements <br /> SAMPLE RECEIPT Date Time Samples Relinquished By Samples Received By <br /> Received Cold Y N 7 cr, 4� <br /> ' Custody Seals Y N Amiks <br /> I — <br /> eals Intact Y N <br /> i <br /> No of Containers <br /> Acculabs'terms are Net 40 (Payment must be received by the date shown on the Invoice or any discount is void) <br />