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<br />Laboratory and Radiation Services Division <br />8100 Lowry Boulevard_nan.~'°"^°`- <br />~`~.><•~ US Mail F <br />c°u"°° om~r (303) 692 System ID IN~-2.( <br />`rPu611c~'" Collection Date <br />Control Plumber <br />REQUEST FOR A <br />F, CustomedD <br />-E' Name : ~L~('~ ~ 't~.GL IrG lbK~ <br />~ Address: 131.3 SHE ?'~~5~ ~ a 1 S <br />~t ~P: ~~~[~[ "'mil CQ~ "`atrv~ <br />Contact <br />Phone: <br />PWS ID: ~ ~ J ~ LJ <br />Sample Location: -1~- . f I p 1 Q 1-' <br />Description: <br />_~ Address: <br />~' City: St Zip: <br />Collected:{-~~ ~ ~/~ Y ~~ jr~l I~ f Time: ~ qi~~n ~ ~ ~ . ~~ ,~ ^amn. <br />morrtlr day year-1 uhourL~'J i~miFn~ Q P' <br />collected ey: ~ Makes: <br />^ surface water <br />^ Ground Water <br />^ Treated Water <br />Purpose : ^ Routine ^ Spedal Purpose ^ Repeat ~-7 <br />Chlorine residual: ~rr^^ MGlL Temp., Water. ^I IF <br />Comments: <br /> TEST ORDER (Check appropriate box) : 0 <br />CHEMISTRY-INORGANIC I CHEMISTRY-ORGANIC RADIOCHEMISTRY <br /> <br />^ Alkalindy, Phenolphthalein <br />^ Molybdenum I <br />~ ^ Carbamates <br />^ Alphal8eta, Gross <br />^ Alkalinity, Total ^ Nickel ~ ^ VOC ^ Amedctum <br />^ Aluminum ^ Nitrogen. Ammonia Oist. ^ 7HM ^ Carbon-t4 <br />^ Antimony ^ Nitrogen, Kieklahl ^ BTEX ^ Gamma Sereen <br />^ Arsenic ^ Nitrogen, Total ^ DtOUAT Gamma Spectrometry, <br />^ Badum ^ NiVatelN@rite ^ SOC ^ NuGide Specific <br />^ Beryllium ^ NitrAte ^ SVOC ^ Leak Test <br />^ BOD ^ pft ^ Pesticides ^ Plutonium <br />^ Boron _ ^ Plwsphate, Orlho ^ Gfypfiosate ^ Radium 226 <br />p Cadmium ^ Phosphate, Total ^ Herbiades ^ Radium 228 <br />^ Cakaum ^ PrKassium ^ EDBJDBCP ^.Radon <br />^ Chbdde <br />^ Selenium ^ PCB ^ Thorium <br />C Chlorine, total residual ^ Silicon (silicates) ^ TOC ^ Tritium <br />^ Chromium ^ DRO ^ Other. <br />^ Conductivity ^ SiHer ^ HEM (Oil Grease) ^ Other. <br /> <br />^ Copper ^ Sodium ^ er. <br /> <br />^ Conostv'rty (pro ~p-) ^ Sohds, Dissolved r <br />MICROBIOLOGY <br />^ Cyanide, Dist ^ Solids, Suspended <br />^ Fluoride G' SWids, Tota ^ Total Colifomu, PA <br />^ Hardness total ^ SuHate phase 1,2,5 -ANALYSES ^ Total Colifonns, MTF <br />^ Iron ^ Thallium ~ ^ Heterotrophie Plate Countm <br />G7 Lead ^ Uranium ^ Organic (SOC / VOC) ^ Pseudomonas MPN m <br />^ Magnesium ^ Zmo ^ Inorganic ^ E. Coll., MPN G <br />^ Manganese I <br />^ Other: ^ Other. ," <br />^ Mercury ^ Other. , ^ Other. ~ <br /> ~ <br /> <br />~ _ <br />~ a <br />r di L ~ I / <br />- L i ~ <br /> <br /> <br />Rgvttr250R¢Q, Rav 17All99 <br />