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Acculabs Inc. <br /> 1 <br /> [ ]1725 W. 17thLab Number <br /> .St.Tempe AZ 85281 480-967-1310 Fax 967-1019 i ]r0 <br /> [ ]4455 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 /> i ]75 Suttle St.Durango CO 81301 970-247-4220 Fax 247-4227 <br /> t [ <br /> 14663 Table Mountain Dr.Golden CO 80403 303-277-9514 Fax 277-9512 <br /> [ ]992 Spice Islands Dr.Sparks NV 89431 775-355-0202 Fax 355-0817 <br /> Client �� 0^ C A 1 . <br /> 'V Fax Results Y N <br /> Page of <br /> Address '~ x s <br /> SUPPLY INFQRMATION" <br /> City,State&Zip D n k,j [ S6 ), v System Name <br />{ Contact r <br /> PWS No. Report to State/EPA Y N <br /> Phone �, T3J— Collector's Name POE No. DWR No. <br /> Fax lb S3.r oA 6 Project Name QQ�/ � _ Collection Point <br /> P.O.Number Project Number {QQ p Location(City) <br /> ...SAMPLE TYPE CODES !Q12 <br /> Analyses <br /> DW=drinking water TB=travel blank Compliance S C� Requested <br /> WW=waste water SD=solid Monitoring f <br /> a '0 : <br /> 0 L } <br /> MW=monitoring well SO=soil <br /> 4 HW=hazardous waste SL=sludge Y N p 9 t <br /> ! a " <br /> `�=� W U NARWND;.TwE;REQU_StED15 � <br /> ka <br /> Standard �s <br /> Lab Manager n <br /> T �- <br /> RUSH Approval e" <br /> Special lip,IN, <br /> CLIENTS'SAMPLE IDIL�CATION Date Time ` - Spl. No. <br /> W, p az <br /> w <br /> A0og <br /> VA V-�� oq <br /> t <br /> Instructions/Comments/Special Requirements: <br /> �z gs , el wished B�a 5amt <br /> AI41P#_E#2ECElPT=q Dates TimeSs�mP� y " <br /> ples Received _y: . <br /> Received Cold Y N C7� I b <br /> Custody Seals Y N 1 <br /> Seals Intact Y N <br /> Containe ` <br /> rs f <br /> ..w �. - "�e."` , fr ap •n f iia;. n -z.ssbi <br /> .., Acculabs rterms are` Net a0 (PaymenC;rnust berecelvedby the date sFiown�on the lnvoEce or�art discount Is�Vaad} <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 /> A301E <br />