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r <br />Laboratory and Radiation Services Division <br />8100 Lowry Boulevard, Denver CO 802346928 <br />-,.K US Mail: PO Box 17123, Denver CO 80217 <br />dr.uK~m (303) 692-3090 fax (303) 3449989 <br />~ raw~~ <br />REQUEST FOR ANALYTICAL SERVICES <br />CustomerlD <br />Name :~ <br />Adds: ~~ s+~ a <br />Contact: \ /'~` ~] <br />PAone~'3~~ 1 D (~ W~ r/- <br />PWS 10: <br />Sample Location: <br />Description: L <br />Address: ~~ <br />City: ( St: Zip: <br />System ID <br />Collection Date <br />Control Number <br />Collection No: <br />nvazooaooooi) <br />1 /5/2004 9:57:OOAM <br />8 <br />Collected: ~W/LJ~J~uL7J Tune: t-li ~ I' -~J~ ~~'am. <br />month day year hour min ~ P.m. <br />Cdleded by: ® Matron: <br />(~Sudace water <br />^ Ground Water <br />^ Treated Water <br />Purpose : Routine ^ Special Puryose ^ Repeat <br />Chlorine residual: ~ ~ ~ <br />^ MGIL Temp.. Water. ^ ~ F <br />CommeMS: T~1errri'ryr e,i '~.S ';`~J'('{Dt'b <br />TEST ORDER (Check appropriate box) : ~ <br />CHEMISTRY- INORGANIC ~ CHEMISTRY- ORGANIC RADIOCHEMISTRY <br />^ Alkalinity, Phenolphthalein ^ Molybdenum ~ ^ Carbamates ^ Alphal8eta, Gross <br />^ Alkalinity, Tonal ^ Nickel I ^ VOC ^ Americium <br />^ Aluminum ^ Nitrogen, Ammonia Dist ^ THM ^ Carbon-14 <br />^ Antimony ^ N'rboyen, Kleldahl ^ BTIX ^ Gamma Screen <br />^ Arsenic ^ Nitrogen, ToW ~ ^ DIQUAT Gamma Spectrometry, <br />^ Barium ^ Nitrate/Nitrite ^ SOC ^ Nudide Specific <br />^ Beryllium _ ^ Nitrite ^ SVOC ^ Leak Test <br />BOD ^ pry ^ Pestuades ^ Plutonium <br />^ Boron ^ Phosphate, Ortla ^ Glyphosate p Radium 226 <br />^ Cadmium ^ Phosphate, Total ^ tierbiddes ^ Radium 228 <br />^ Calcium ^ Potassium ^ EDB/DBCP ^ .Radon <br />^ Chbnde C Selenium - ^ PCB ^ Thodum <br />^ Chlorine, total residual <br />^ Silicon (silicates) ^ TOC ^ Tritium <br />^ Chromium ^ DRO ^ Other. <br />^ CorMUdivily ^ SiNer ^ HEM (Oil Grease) ^ Other. <br />^ CoPPer ^ Sodium ^ Other. <br />^ Corrosiv. record t, ^ Solids,DissoNed ^ Other. <br />MICROBIOLOGY <br /> <br />^ Solids, suspended <br />C snide, Dist <br />^ Fluoride ^ salds, Total ^ Taal Col'dorms, PA <br />^ Hardness, total ^ Sulfate phase 1,2,5 -ANALYSES ^ Taal Colifomu, MTF <br />^ Iron ^ Thallium ~ ^ Neterotrophic Plate Count <br />^ Lead ^ Uranium I ^ Organic (SOC / VOC) ^ Pseudomonas MPN <br />C Magnesium ^ Zinc ^ Inorganic ^ E. Colt., MPN <br />^ Manganese ^ Other. _ - ~ ^ Other. <br />^ Mercury ^ Other. `~ , <br />I <br />i ^ Other. <br /> <br />Internet Address: http-l/www.cdphe.state.co.usfldlrhom.htm <br />a,e_ a_..,...e,. / <br />