Laserfiche WebLink
~cculabs Inc. Lab Number <br />I i 1725 W. 77th. St. Tempe AZ 85281 602-967-1310 Fax 967-1019 Q ?- ~ 3 - QOj -~ <br />I J 4455 S. Park Ave. Tucson AZ 85714 520-807-3801 Fax 807-3803 Report <br />I ) 2020 W. Lane Cactus Dr. Phoenix AZ 85027 602-780-4800 Fax 780-7695 Due Dale. - ~ ~ <br />J 12029 N. 4th. St. Flagstaff AZ 86004 520-774-7643 Fax 774-7648 <br />J 1045 Olive Drive Davis CA 95616 530-757-0920 Fax 753-6091 <br />J j 75 Sunle St. Durango CO 81301 970-247-4220 Fax 247-4227 <br />I 14663 Table Mounlaln Dr. Golden CO 80x03 303-2779514 Fax 277-95t2 <br />( J 992 Spice Islands Dr. Sparks NV 89431 702-355-0202 Fax 355-0817 <br />Client j'~ 1 ~~+~~ 1 PUBLIC WATER SUPPLY INFORMATION <br />Address Z G Z ) Z d System Repon le Stale 1' N <br />City. Stale & Zip L ~ Q Z PWS No. Repon to. EPA Y N <br />Cenla.Cl r POE No. DWR No. <br />Phone Z 5 ~ - 2 I Project Name Collection Point (~ <br />Fax Project Number Collector's Name ~ -~ <br />P O. Number F..=.x P.esults Y N Paoe of Location (City) <br />SAMPLE TYPE CODES ~ Analyses <br />DVJ =drinking water TB =travel blank <br />W'N' =waste water SD = so0d <br /> <br />,9(Y monitoring well SO =soil <br />Hl1' =Hazardous waste SL =sludge Compliance <br />Monitoring <br /> <br />/;1 N <br />~ s <br />a <br />m <br />p <br />I C <br />o <br />n <br />t <br />a Requested \q' ` <br />c <br />- Lr j~~ <br />~~j ~ yx <br />~ ,~ <br />TURNAROUND TIME REQUESTED e i ~' C' G 4 <br /> <br />tantla <br />Lab Idanager <br />T n <br />e ill <br />!7 /~• \ ~~ <br />RUSH Approval y r ~~% (` y/ ,/ ~ <br /> <br />Special p <br />e s a r- <br />~J ~ <br /> <br />CLIENT'S SAMPLE ID/LOCATION <br />Date <br />Time v <br />Spl. No. <br />~ ~ ~~- ~ s'.5~~ m~ ~ ~( <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />InstructionslCOmments/Special Requirements: <br /> <br />SAMPLE RECEIPT Date Time Samples Relinquished B Samples Received By <br />Received Cold Y N ~~~ 9Q `Q-~,-m <br />Custody Seals Y N <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 />