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' Acculabs Inc. Lab Number aa <br /> ^ <br /> [ ]1725 W 17th St Tempe AZ 85281 480-967-1310 Fax 967-1019 S 0 <br /> [ ]4-455 S Park Ave Tucson AZ 85714 520-807-3801 Fax 807-3803 Report <br /> [ ]2029 N 4th St Flagstaff AZ 86004 520-774-7643 Fax 774-7648 Due Date <br /> [ ] 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 Or Golden CO 80403 303-277-9514 Fax 277-9512 <br /> [ ]992 Spice Islands Or Sparks NV 89431 775-355-0202 Fax 355-0817 <br /> Fax Results Y N Page of <br /> Client ,17 <br /> ' Address �r✓C / e r� �1c� hew / PUBLIC WATER SUPPLY INFORMATION <br /> City State&Zip /�/ c cCCI-LI �J�r �z System Name <br /> ' Contact if C! re 14 PWS No Report to StateSPA Y N <br /> Phonet� ` ~ Collector's Name r c A-IC914t POE No DWR No <br /> Fax Project Name -!r 61:g4cc riwal' Collection Point <br /> P O Number Project Number f 7q%.5(—,. Location(City) <br /> SAMPLE TYPE CODES Analyses <br /> ' DW=drinking water TB=travel blank Compliance S C Requested <br /> WW=waste water SD=solid Monitoring a o <br /> m n <br /> MW=monitoring well SO=sod Y N p It <br /> HW=hazardous waste SL=sludge I a <br /> tTURNAROUND TIME REQUESTED e I '►�` <br /> Standard Lab Manager n ,q <br /> RUSH Approval T r <br /> y <br /> Special p s �J at~ <br /> CLIENTe S SAMPLE IDILOCATION Date Time Spl No <br /> #-lac, -Z -�r- � r /]�f: l ✓ ✓ <br /> b <br />� 1 <br /> Instructions/Comments/Special Requirements C.G'xrY}vl RI 6G tc <br /> SAMPLE RECEIPT Date Time Samples Relinquished By Samples Received B <br /> Received Cold Y N 711-1)'(? !�•�S C L� t�[t*�r x/ <br /> ' Custody Seals Y N <br /> Seals Intact Y N <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 /> To the maximum extent permitted by law the Client agrees to limit the liability of Acculabs Inc for the Client s damages to the total compensation received <br /> unless other arrangements are made in writing This limitation shall apply regardless of the cause of action or legal theory pled or asserted <br /> ' A301 <br />