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Acculabs Inc. L-a7b Nu~m}-bQer <br />[ ] 3902 E. University Dr. Phoenix AZ 85034 602-437-0979 Fax 437-0826 ~~ f ~ 1 1 <br />[ ] 710 E. Evans Blvd. Tucson AZ 85713 520-884-5811 Fax 884-5812 Report <br />I ] 2020 W. Lone Cactus Dr. Phoenix AZ 85027 602-780-0800 Fax 780-7695 Due Date: I ~ -~~'~ <br />I ) 4663 Table Mountain Dr. Golden CO 80403 303-277-9514 Fax 277-9512 <br />[ ) 992 Spice Islands Dr. Sparks NV 89431 702-355-0202 Fax 355-0817 <br />I ) 75 Sullle St. Durango CO 81301 970-247.4220 Fax 247-4227 <br />Client <br />A~ 1 nn ~}, 1 'PUBLIC WATER SUPPLY INFORMATION <br />~y <br />Address 1 ~"I `' ~ . <br />a System Name <br />'~ y `` <br />/ <br />City, Stale & Zip CO I, 1 PWS No Report to Slate/EPA Y N <br />Contact POE No DWR No <br />Phone Project Name Collection Point <br />Fax Pro)ect Number Collector's Name ~' CT-zLe(L <br />P.O. Number Fax Results V N Page of Location (City) <br />SAMPLE TYPE CODES Analyses <br />DW =drinking water TB =travel blank <br /> <br />= avast ater SD =solid <br /> <br />MW =monitoring well SO =soil <br />HW =hazardous waste SL =sludge Compliance <br /> <br />Monitoring <br /> <br />~, N S <br />a <br />m <br /> <br />p <br />I ~ <br />o <br />n <br /> <br />t <br />a Requested <br /> <br />0 <br />:~ <br />.7 <br />0 <br />TURNAROUND TIME REQUESTED e I <br /> <br />Standard <br />Lab Director <br />T n <br />e ~I <br />n 17 `/ <br />RUSH Approval y ~ r <br />s b Ir <br />!I <br />~ <br />Special e~- ~ <br />~ <br />V ~ A ` <br />CLIENT'S SAMPLE IDILOCATION Date Time ~ ~V <br />Q Spl. No. <br />1Q ~ctm ~ q'S 9 ~ -5 M~ I <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />InstructionslCommentslSpecial Requirements: <br /> <br />SAMPLE RECEIPT Date Time Samples Relinquished By Samples Received By <br />Received Cold Y N ~~r~ <br />Custody Seals Y N <br />Seals Intact Y N <br />No. of Containers <br />Acculab's terms are: Net 40 (Payment must be received by the date shown on the Invoice or~any discount is void) <br />c'\excel\forms\chain xls <br />