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F8733 Rev <br /> Acculabs Inc. Lab Number > O <br /> V[ 1046 Olive Drive Davis CA 95616 530-757-0920 Fax 753-6091 <br /> [/]76'Suttle St Durango CO 81301 970-247-4220 Fax 247-4227 Report <br /> [ ]4663 Table Mountain Dr Golden CO 80403 303-277-9514 Fax 277-9512 Due Date <br /> ]992 Spice Islands Dr Sparks NV 89431 775-355-0202 Fax 355-0817 <br /> Client Fax Results Y N Page of <br /> Address PUBLIC WATER SUPPLY INFORMATION_ <br /> ' City,State&Zio <br /> rr System Name <br /> Contact LIa C- PWS No Report to State/EPA Y N <br /> Phone 2 ��' Collector's Na POE No DWR No <br /> Fax Mi 7 Ebps-O Project Name d- " Collection Point <br /> P O Number ' -0Project NumbeZ g1 -3 1 7az�,,� loty County <br /> SAMPLE TYPE CODES S a C Analyses <br /> o <br /> ' t)W=drinking water TB=travel blank Compliance m n Requeste C� <br /> WW=waste water SD=solid Monitoring P <br /> I a <br /> MW monitoring well SO=sod Y N e I <br /> I HW=hazardous waste SL=sludge n <br /> TURNAROUND TIME REQUESTED T e Gn <br /> St rd Lab Manager y <br /> nda <br /> Approval P $ <br /> e <br /> Special <br /> CLIENT'S SAMPLE IDILOCATION Date I Time I Spl No <br /> f ,,v — .� t�-1`. of <br /> KVJ <br /> L1-r r�.ct N LS <br /> I <br /> I <br /> I <br /> 1 <br /> Instructions/Comments/Special Requirements <br /> SAMPLE RECEIPT Date Time Sam Ies Relinquished By amples Re eived By <br /> Received Cold Y N � <br /> ' VV <br /> Custody Seals Y N <br /> Seals Intact Y N <br /> i No of Containers <br /> Acculabs, Inc's Standard Terns and Conditions applv unless written agreements specify otherwise Payment terms are Net 30 <br /> To the maximum axtent permitted by law the Chen,agrees to l,rmit'he i,aodhty of Acculabs, Inc for the Chants damages to the total compensation <br /> ' received unless other arrangements are made in wntsng This Limitation shall apply regardless or the cause at action or legal theory pied or assertea <br /> 3G1 2W <br />