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1 - - L9borab <br />\ <br />~ 8100 La <br />`~•••' US Mail <br />~~~ (303) 6S <br />or Miic HdtA <br />.,,a e,h~,,,•~ <br />system 1D IN0.200400 1 23 1 <br />Collection Date 4/12/2094 9:90:OOAM <br />Control Number ) <br />REQUEST FOR . __ __ __ <br />CustomeriD .WQ~to2&9 <br />Name : P f~2tL'~a.~ ~~.~~ <br />Address: `~~~ SK~~ S~ QM ~, <br />citylstrp: ~ ~ ~L C~ <br />Contact $ ~ K~~{~Z <br />Phone ~ 03 ~ 0 66 -~O'lr~ <br />Pws 1D: ~ i U U L i U U <br />Sample Location: (~~-i-II r~P L-~ . <br />Description: ~_ ~ V <br />Address: ~~ ( t.~t)12~ C-e~ <br />City: St rip: <br />Collected: Uf it /I / IrLi/1 OIW . Tane. ~/J U~`/ x'40 ~I - a m. <br />mon& dayLU daJiy.J~L_ye11ar1J uhour~• ~ uminL-1 <br />Collected by. I I Matruc: ~~ <br />LLJ ^ surface water <br />- ^ Ground water <br />^ Treated Water <br />Purpose : ^ Routine ^ Special Purpose ^ Repeat <br />Chlorine residual: ~~^~ MGlL 7emp.,Water. ~f /' <br />Comments: <br />TEST ORDER (Check appropriate box) : ~ <br />CHEMISTRY-INORGANIC CHEMISTRY- ORGANIC RADIOCHEMISTRY <br />^ Alkarin'dy, Phenolphthalein ^ Molybdenum ~ ^ Carbamates ^ Alpha/Beta, Gross <br />^ Alkarindy, Total ^ Nickel I ^ VOC ~ ^ Ameridum <br />^ Aluminum ^ Nitrogen, Ammonia D'at ^ THM ^ Carbon-14 <br />^ Arrtimony ^ Nibogen, FGeldahl ^ BTIX ^ Gamma Sereen <br />^ Arsenio ^ Niuogen, Total ^ DIQUAT Gamma Spectrometry, <br />^ Barium D Nitrate/N'rtrite p SOC ^ Nuclide Specific <br />^ Beryllium ^ Ndryte ^ SVOC ^ Leak Test <br />'I, <br />^ gpp ~l'pFt ~"T~ ^ Pestiddes ^ Plutonium <br />^ Boron ^ Phosphate, Ortho ^ Gyphosate ^ Radium 226 <br />^ Cadmium ^ phosphate, Total ^ Herbiades ^ Radium 228 <br />^ Caldum ^ potassium ^ EDBlDBCP ^.Radon <br />^ Chloride C Selenium ^ PCB p Thorium <br />^ Chlorine, total residual <br />^ SGicon (silicates) ^ TOC ^ Tritium <br />^ Chromium ^ DRO ^ Other. <br />^ Corductivdy ^ Siker ^ HEM (Oil Grease) ^ Other. <br />^ Sodium <br />^ Copper ^ ~~ <br />^ Cortosiv record temp. ^ Solids, Dissolved ^ Othec <br />MICROBIOLOGY <br />d sorbs, suspended <br />ankle, Dist. <br />^ Fluoride ^ Solids, Total ^ Total Coliromu, PA <br />^ Hardness, total ^ sulfate P/lase l,2,5 -ANALYSES ^ Total Colifomrs, MTF <br />^ Iron ^ Thallium ~ ^ Heterotrophic Plate Count <br />4ead ^ Uranium I ^ Organic (SOC! VOC) ^ Pseudomonas MPN <br />C Magnesium ^ Zinc ^ Inorganic ^ E. Coli., MPN <br />^ Manganese ^ Other. ^ Other. <br />_n, Mercury ^ Other. ^ Other. <br />d <br />~ ~ °Z ~~ ~ ~ <br />rn, n <br />G 12.gs <br />,lam _ a <br /> • <br />LARS Internet Address: http://www.cdphe.state.co.us/Ir/irhom.htm <br />RapalfL40Req Rav 11AU99 <br /> <br />