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' Lab Number <br /> Accu[abs Inc. <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 /> j 2020 W Lone Cactus Dr Phoenix AZ 85027 602-780-4800 Fax 780-7695 Due Date <br /> j 2029 N 4th St Flagstaff AZ 86004 520-774-7643 Fax 774-7648 <br /> ' <br /> J41046 Olive Drive Davis CA 95616 530-757-0920 Fax 753-6091 <br /> [ ]75 Suttle St Durango CO 89301 970-247-4220 Fax 247-4227 <br /> [ ]4663 Table Mountain Dr Golden CO 80403 303-277-9514 Fax 277-9512 <br /> [ ]992 SpEce Islands Dr Sparks NV 89431 702-355-0202 Fax 355-0817 <br /> Client PUBLIC WATER SUPPLY INFORMATION <br /> r <br /> Address 9- n 6iti <br /> 4� System Report to State Y N <br /> City State&Zip //(,� Pt lo(- <br /> PWS No Report to EPA Y N <br /> Contact jj) a !o �l POE No DWR No <br /> Phone 3?6-3 cY o Project Name Collection Point <br /> Fax C, r Project Number S Collector's Name <br /> ' P O Number Fax Results ny N Page of 2— Lo tion ) <br /> SAMPLE TYPE CODES _ _ Analyses <br /> DW=drinking water TB=travel blank Compliance -S C Requested 0 <br /> ' <br /> WW=waste water SD=solid Monitoring a o m n <br /> MW=monitoringwell SO=soil � <br /> Y N P ttJ <br /> HW=hazardous waste 5L=sludge I a <br /> TURNAROUND TIME REQUESTED = e I <br /> lVecial <br /> '/ Lab Manager T e <br /> �Y / rAr Approval Fyr <br /> P s <br /> e <br /> T'S SAMPLE I iLOCATION `Date Time Spl No <br /> -T7 �3 <br /> b p; ob <br /> 6.3 07 <br /> 0 C3 <br /> Instructions/CommentstSpecial Requirements <br /> SAMPLE RECEIPT ~`Date Time Triple ' hnq s end B� -� Sain les cerved1By <br /> Received Cold Y N <br /> ' Custody Seals Y N 1t hg [ELS <br /> als Intact Y N <br /> No of Containers <br /> Accu labs'terms are Net 40 (Payment must be received by the date shown on the Invoice or any discount is void) <br /> r <br />