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ACCUlabs Inc. <br /> Lab Number <br /> [ ] 1725 W. 17th.St.Tempe AZ 85281 602-967-1310 Fax 967-1019 <br /> [ ]4455 S.Park We.Tucson AZ 85714 520-807-3801 Fax 807-3803 Report <br /> [ ]2020 W. Lone Cactus Dr. Phoenix AZ 85027 602-780-4800 Fax 780-7695 Due Date: <br /> [ ]2029 N.4th. :t. Flagstaff AZ 86004 520-774-7643 Fax 774-7648 <br /> [ j 1046 Olive Dr ve Davis CA 95616 530-757-0920 Fax 753-6091 <br /> [ j 75 Suttle St.Durango CO 81301 970-247-4220 Fax 247-4227 <br /> [ j 4663 Table Mountain Dr. Golden CO 80403 303-277-9514 Fax 277-9512 <br /> [ ]992 Spice Isl2nds Dr.Sparks NV 89431 702-355-0202 Fax 355-0817 <br /> Client r ;��� PUBLIC WATER SUPPLY INFORMATION <br /> Address System Reportto:State Y N <br /> City, State&Zip / . , �/ 2-0 PWS No. Report to: EPA Y N <br /> Contact (� J PO No. DWR No. <br /> Phone — ?7 Project Name 7 ollection <br /> L Z� CPoint <br /> Fax 9 IS--IGL7 — 061 Project Number Collector's Name , <br /> rte. / <br /> P.O. Number Fax Results Y N Page ( of Locatio lty) <br /> SAMPLE TYPE CODES Analyses v <br /> DW=drinking water TB=travel blank Compliance S C Requested n <br /> WW=waste water SD=solid Monitoring m n ®� <br /> MW=monitoring well SO=soil Y N p t <br /> HW=hazardous wE ste SL=sludge I a <br /> TURNAROUND TIME REQUESTED e I ✓ <br /> n <br /> Standard Lab Manager T e <br /> SH —C; Approval y r <br /> pecial �� e s <br /> �!✓ <br /> e <br /> CLIENT'S SAMPLE ID/LOCATION Date Time Spl. No. <br /> p: `r b S of <br /> / 0Z <br /> - :10 0+ <br /> 06 <br /> C�- /Y-2-3 C9 <br /> is"; <br /> Instructions/Comments/Special Requirements: <br /> SAMPLE RECEIPT Date Time apn7t9s Relinquished By Samples Received By <br /> Received Cold Y N <br /> Custody Seals Y N <br /> Seals Intact Y N <br /> No.of Containers <br /> Acculaos'terms are: Net 40 (Payment must be received by the date shown on the Invoice or any discount is void) <br />