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F8733 Rev B <br />l~cculabs Inc. LabN-uJmber cr <br />[ ] 1725 W. 17th. St. Tempe AZ 85281 480-967-1310 Fax 967-1019 (- Q ~ l -~ ~ 7 ~ <br />( ] 4455 S. Park Ave. Tucson AZ 85714 520-807-3801 Fax 807-3803 Report <br />] ) 2029 N. 41h SL Flagstaff AZ 861104 5?0.774-7643 Fax 774-7648 Due Dale: <br />[ ] 1046 Olive Drive Davis GA 95616 530-757-0920 Fax 753-6091 <br />[ ] 75 Sullle St. Durango CO 81301 97D-247-4220 Fax 247-4227 <br />[ ) 4663 Table Mountain Dr. Golden CO 80403 303-277-9514 Fax 277-9512 <br />[ ] 992 Spice Islands Dr. Sparks NV 89431 775-355-0202 Fax 355-0817 <br />Client Fax Results Y N Page of <br />Address A/yZ <br />G(Z / Z PUBLIC WATER SUPPLY INFORMATION <br />/I <br />City, State 8 Zip ~"r't C~ ~ ~ 3 Z System tJame <br />Contact 1 PWS No. Report to State/EPA Y N <br />Phone Collector s Name !'f,2if^~ POE No. DWR No. <br />Fax Project Name Collection Point <br />P.O. Number Project Number Location (City) <br />SAMPLE TYPE CODES Analyses <br />DW =drinking water TB =travel blank <br /> <br />WW=wastewater SD=solid <br />MW =monitoring well SO =soil <br />HW =hazardous waste SL =sludge Compliance <br /> <br />JylOnitoring <br />(1Kv <br />N S <br />a <br />m <br /> <br />~ P C <br />o <br />n <br /> <br />a Requested <br /> <br />A <br /> <br />t/ <br /> <br />'' .TURNAROUND TIME REQUESTED <br />e <br />I e~ <br /> <br />Standard <br />Lab Manage <br />n r <br />RUSH gppr~ T <br />y e <br />r <br /> <br />Special <br />p <br />s r <br />~ V <br /> <br />~C~IENT'S SAMPLE IDILOCATION <br />Date <br />Time e <br />Spl. No. <br /> l u) <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />Instructions/Comments/Special Requirements: <br /> <br />SAMPLE RECEIPT Date Time S pies R quished By Samples Received By <br />Received Cold Y N ~ <br />Custody Seats Y N <br />Seals Intact Y N <br />No. of Containers <br />Acculabs' terms are: Net 40 (Payment must be received by the dale shown on the Invoice or any discount is void) <br />To the maximum extent permitted by law, the Client agrees to limit the liability of Acculabs Inc. for the Client's damages to the total compensation received <br />unless other arrangements are made in writing. This limitation shall apply regardless of the cause of action or legal theory pled or asserted. <br />A301E <br />