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8G4~ sa 7S- <br />Laboratory and Radiation Services Division <br />' 8100 Lowry Boulevard, Denver CO 80230-6928 <br />• ~• US Mail: PO Box 17123, Denver CO 80217 <br />cebam Dept (303) 692-3090 fax (303) 3449989 <br />dr,biic lbitl~ <br />d Fmvomem <br />REQUEST FOR ANALYTICAL SERVICES ~„~on,.f,; <br />~ ~ <br />[ <br />r~ CustomerlD <br /> Name: <br /> <br /> Address <br /> CilylSt2ip: <br /> Comari <br /> <br />~ • <br />,E PWS ID: <br />. Sample Location: <br />l <br />t <br />. ~ Desc7~tion: <br /> Address: <br />~ C <br /> ~' ~1 <br />`~' am. <br />~f{lti1~~F'M t.! C.Ga• II coneaed: LUtiLi~lL)J~~L~JI~I rxne: I j~T ~;L,~~ <br />31 ~ ~ ~ ~ , ~1 ~ '' Cdkded b ~~ Matruc: mm <br />~.,.• ~-{~ ~v~ ~LS~ ^ Surface WaOer <br />/,,•`~~ " `"~~~ ^ Grouts Wakr <br />1• ~ ~~ ~ H T ~ ~ ' I ^ Treated WaOer <br />~I Purpose : ^ Routine ^ Spedal Purpose ^ Repeat ~''~ <br />Chlorine residual: ~ a ~ ~ MG/L Temp., yyater. ^ I I F <br />CommerRs: :J <br />St Lp: <br />TEST ORDER (Check appropriate box) : ~ <br />CHEMISTRY-INORGANIC CHEMISTRY-ORGANIC RADIOCHEMISTRY <br />I <br />^ Alkalinity, Phenolphthalein ^ Molybdenum i ^ carbamates ^ AlpnalBeta, Gross <br />^ Agkalinity, Total ^ Nickel I <br />~ ^ VOC ^ Americium <br />^ Aluminum ^ Nitrogen, Ammonia Dist. ^ THM ^ Carbon-14 <br />^ Antimony ^ Nitrogen, fGeldahl ^ BTIX ^ Gamma Screen <br />^ Arsenic ^ Nitrogen, ToW ^ DIQUAT Gamma Spectrometry, <br />^ <br />^ Barium ^ NitrateMRrde ^ SOC Nuclide Specific <br />^ Beryeium ^ Nilri.~ ^ SVOC ^ Leak Test <br />G BOD ^ PH ^ Pesticides ^ Plutonium <br />^ Boron ^ Phosphate, OMo ^ Gyphosate ^ Radium 226 <br />^ Cadmiurrr ^ Phosphate, Total ^ Herbicides ^ Radium 228 <br />^ Calcium ^ Potassium ^ EDB/DBCP ^ Radon <br />^ Chbride C Selenium ^ PCB ^ Thorium <br />^ Chlorine, total residual <br />^ Silicon (silicates) ^ TOC ^ Tritium <br />^ Chromium ^ DRO ^ Other. <br />^ Siher <br />^ Conductivity ^ HEM (Od Grease) ^ Other. <br />^ Sodium <br />^ Copper Other. <br />^ <br />^ Sogds, Dissolved <br />^ Corrosively (record tergp.) Ottxr. <br />p <br />MICROBIOLOGY <br />Cyanide, D~~~t \) ^ Solids, Suspended <br />Fluoride ^ Solids, Total <br />^ Total Coliforms, PA <br />^ Hardness, total ^ SuHate Phase 1,2,5 • ANALYSES ^ Total Col'domn, MTF <br />^ Iron ^ Thalfwm ^ Heterotrophic Plate Count <br />^ Lead ^ Uranium i ^ Organic (SOC / VOC) ^ Pseudomonas MPN <br />Zinc <br />^ <br />^ Magnesium ^ Inorganic ^ E. Coli., MPN <br />~~~~ <br />////,,,, <br />^ Manganese Other., I ^ Other. <br />r? Mercury er. ^ Other. <br />~~c~rvE® <br />LARS IntemelAddress: hltpJ/www.cdphe.slate.co.us/IrArhom.htm O(rT 2 2 Z(]~~ <br />R•Ven 2d` Rey Rw 1?A799 <br />Division of Minerals and Geology <br />