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Irculabs Inc. Lab Number5 W 17th St Tempe AZ 85281 602-967-1310 Fax 9fi7 10195 S Park Ave Tucson AZ 85714 520-807-3801 Fax 807-3803 Report <br /> 0 W Lone Cactus Dr Phoenix AZ 85027 602-780-4800 Fax 780-7695 Due Date <br /> 9 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 /> [ <br /> '75 Suttle S1 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 /> ClientLT <br /> PUBLIC WATER SUPPLY INFORMATION <br /> ' Address Yac-{` r Y- . System Report to State Y N <br /> City State&Zip Y 72-a PWS No Report to EPA Y N <br /> Contact L PO No 1DWR No <br /> Phone O Project Name 7 c.L-�- T Collection Point <br /> Fax <br /> —f z 7 — 02-2 Project Number Collector's Name , <br /> P O Number Fax Results Y N Page of Locatio ity) <br /> SAMPLE TYPE CODESAnalyses <br /> DW=drinking water TB=travel blank Compliance S -C'-, Requested <br /> WW=waste water SD=solid Monitoring m n <br /> MW=monitoring well 50=sod Y N P t <br /> HW=hazardous waste SL=sludge I a <br /> TURNAROUND TIME REQUESTED e I <br /> n <br /> Standard t Lab Manager Tq_ e <br /> SH — Approval y r <br /> P $" <br /> pedal ;` s F <br /> CLIENT'S SAMPLE ID/LOCATION Date Time SPI No <br /> Ido D `r <br /> Z /r 0z <br /> L 't rr �r o4 <br /> _ <r It( 05 <br /> 112,17 06 <br /> _ as t f r t <br /> ' Instructions/CommentsISpecial Requirements <br /> SAMPLE RECEIPT Data Time /--fkapVjVs Relinquished By Samples Receiv6&B <br /> Received Cold Y N <br /> Custody Seals Y N <br /> Seals Intact Y N <br /> No of Containers _ <br /> ' Acculabs'terms are Net 40 (Payment mutat be received by the date shown on the Invoice or any-dtscounfis void) <br />