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~; <br />Acculabs Inc. Lab Number 2 <br />[ ] 1725 W. 17th. St. Tempe AZ 85281 602-967-1310 Fax 967-1019 ~ /~~~/ <br />[ ) 4455 S. Paris Ave. Tucson AZ 85714 520-807-3801 Fax 807-3803 Report ~ /' <br />[ J 2020 W. Lone Cactus Dr. Phoenix AZ 85027 602-780800 Fax 780-7695 Due Date. ~ L'Z~ ~' <br />[ ] 2029 N. 4th. St. Flagstaff AZ 86004 ~ 520-774-7643 Fax 774-7648 <br />[ ] 1046 Olive Drive Davis CA 95616 530.757-0920 Fax 753-6091 <br />[ [ 75 Suttle St. Durango CO 81301 970-247-0220 Faz 247-4227 <br />[ ] 4663 Table Mountain Dr. Goltlen CO 80403 303-277-9514 Fax 277-9512 <br />Spice Islands Dr. Sparks NV 89431 702-355-0202 Fax 355-0817 <br />[ ] 992 <br />(~ <br />Client 1 1Q~ 1enc~ <br />lei h c ~G[~ <br />~ PUBLIC WATER SUPPLY INFORMATION <br />II <br />~~ <br />Atldress Z-~T C~ ~ "1 System Repon to State Y N <br />City, State 8 Zip E r `" C Q ~~ 1 3 L~ PWS No. RepoA to: EPA Y N <br />Contact <br />^ <br />~ <br />; POE No. DWR No. <br />~ <br />{ <br />f <br />Phone LS - '/r' ~ Protect Name Collection Pornt Cd : V <br />Fax Project Number Collector's Name l f G'~ <br />P.O. Number Fax Results Y N Page of Location (City) <br />SAMPLE TYPE CODES Analyses <br />DW =drinking water TB =travel blank <br />WW =waste water SD =solid <br />monitorin well SO =soil <br />HW =hazardous waste SL =sludge Compliance <br />Monitoring <br />Y N <br />~ S <br />m <br />p <br />I C <br />n <br />t <br />a Requested ~ R. <br />~~ <br />t. v O v _ <br />~~ 5~~~ <br />~ <br />TURNAROUND TIME REQUESTED e I \ a' <br />C ~~ 7r <br /> <br />Standard <br />Lab Manager <br />T n <br />e t' <br />y YO G l~ ~ 7j <br /> Approval y r <br />v 4J <br />Special p <br />e s ~ <br />W V <br /> <br />CLIENT'S SAMPLE IDILOCATION <br />Date <br />Time / y <br />Q <br />~ r C Spl. No. <br />~J c l -3 ti ~ M~ <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />InstructionslCommentslSpecial Requirements: <br /> <br />SAMPLE RE IPT Data Tlme Samples Rellnqulshed B Sam les Received B <br />Received Cold Y N ~ ', -`~u ~ ~• ~~ .. i <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 />