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<br />Accu{abs Inc Lab::~mb?r <br />. <br />[ ] 1725 W. t7lh. St Tempe AZ 85291 480-y5%-1310 Far. 957-1015 7 - t7~ ~- ~ 7 ~ ' ~ f <br />[ ~] 4455 S. Park Ave Tucson AZ 85714 520-807-3801 Far 807-3903 Report <br />[ ] 2029 N. 4th St Flagstaff AZ 8600a 520774-7643 Fax 774 7648 Due Date: _ <br />[ I t045 Oiiv? Grrve Davis CA 95615 530-757-0920 Fex 753-6091 <br />( ] 75 Suttlz St Durango CO 8130r 9 70 24 7-4 220 Fax 247-x227 <br />[ ] 4663 Table Mountain Dr. Golden CO 80403 303277-9514 Fax 277-9512 <br />( ] 992 Spew Islantls Dr Spa[k NV 99431 775-3550202 Fax 355 0817 <br />r [ / <br />Client ~' ~ ~77 % <br />• r 4~~ <br />` ~~ l L~~- <br />Fa. Results Y N <br />Page of <br />' J <br />y~ <br />Atldress ~ ~t C. /.~ :~L C-` PUBLIC WATER SUPPLY INFORMATION <br />ZIo ,~ <br />Cny, State B <br />(~S <br />L! 5 / <br />( (' ~- ` J.><~ ~ Svstem PJam? <br />J <br />? <br />T <br />Contact / G' ~) /~ . ~ ~L P'JJS PJ O. RepGn to StalelEPA Y N <br />Phone Couectors Flame ~ // ~~'~ <br />/ / ryr fvl IZ=C-. I1 •~t POE No. DWR No <br />Fax Project Name Collection Point <br />P O. Number Prolecl Number Location (City) <br />SAMPLE TYPE CODES Analyses b <br />DW =drinking water TB =travel blank Compliance S C Requested <br />'J~MJ =waste water SD =solid Monitoring a o <br />MW =monitoring well SO =soil (//Y??''l/ <br />" m <br />p n <br />t <br />° <br />HW =hazardous waste SL =sludge U 1 a ~ <br />TURNAROUND TIME REQUESTED e I <br />Standard X Lab Manager n <br />RUSH Approval T <br />y e <br />r \ <br />\ <br />Special P s \~' <br />CLIENTS~SAMPLE ID/LOCATION Date Time e \ Spl. No. <br />~.~ l./ 1 /~l~lf0.r W~ I l , ~Lt n~ n~1 ~ .~ i / /7 J <br />Ilnstruclions/Comments/Special Requirements: <br />SAMPLE RECEIPT Date Time Sam les Relinquished By Samples Received By <br />Received Cold / Y N - ~ Id a ~ 0 /~1 ,M _ p~:1:r ~ i~ . ~Q. `_ J.. ~~~ <br />Custody Seals Y N " v " <br />Seals Intact Y N <br />No. of Containers <br />Acculabs' terms are: Net 40 (Payment must be received by the date shown on the Invoice or any discount is void) <br />To the maximum extent permitted by law, the Client agrees to limn the Lability of Acculabs Inc. for the Clients damages to the total compensation received <br />unless other ar-,angements are made in ertiUng. This bmdat~bn Shall apply regardless of the cause of action or legal theory pled or asserted <br />A301E <br />