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r <br /> Accu labs Inc. Lab Number <br /> [ ] 1725 W 17th St Tempe AZ 85281 602-967-1310 Fax 967-1019 © Q <br /> ( 14455S Park Ave Tucson AZ 85714 520-807-3801 Fax 807-3803 Report r_ <br /> ]2020 W Done Cactus Dr Phoenix AZ 85027 602-780-4800 Fax 780-7695 Due Date 1 s [ <br /> ( ]2029 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 /> [ ]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 <br /> sssDr Sparks NV 89431 702-355-0202 Fax 355-0817 <br /> Client �i� (�6r PUBLIC WATER SUPPLY INFORMATION ' <br /> Address lDr, System Report to State Y N <br /> ' City State&Zip - PWS No Report to EPA Y N <br /> Contact POE No DWR No <br /> Phone 3! '' Q/� /� Project Name �L pl �� �( � Collection Point <br /> Fax f� / %/ Project Number Collector's Name <br /> PO Number Fax Results Y N Page of lLcLWtion ) <br /> `SAMPLE TYPE CODES Analyses <br /> DW=drinking water TB=travel blank Compliance 5 C;' Requested 0 <br /> a o <br /> WW=waste water SD=solid Monitoring m n <br /> MW=monitoring well SO=soil Y N P t <br /> HW=hazardous waste St-=sludge I a <br /> ' TURNAROUND TIME REQUESTED e i <br /> n <br /> iandar Lab Manager T e <br /> usf G A Approval y { r <br /> P $ <br /> .cial e , <br /> CLIENT'S SAMPLE IDILOCATION Date Time """JJJ 5pl No <br /> r /6 1 X1 X az <br /> 03 <br /> off'Z' <br /> os- <br /> 3 <br /> s <br /> 1 30 o6 <br /> �Q o5 <br /> IVI IInstructionSICommentsISpecial Requirements <br /> r w _ <br /> SAMPLE RECEIPT Date �T�i`]m`e Samples ReITn wished By, „�a a Samples Received By <br /> Received Cold Y N i� 60 `ustody Seals Y N / <br /> f <br /> eals Intact Y N <br /> No of Containers <br /> Acculabs'terms are Net 40 (Payment must be received by the date shown on the Invotce or any discount is void) <br />