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<br />Lalwratory and Radiation Services Division <br />5100 Lowe-Bnuteva~Denver CO 80230-6928 <br />US Mail: <br />K ~ (303) 69; <br />,,, ,,, system ID IN0.2006002889 <br />Collertionl?ete 1/1/1900 12:0O:OOAM <br />REQUEST FOR, Control Number 106 <br />~. • <br />.4 <br />CuslomerlD <br />~ ~, <br /> 1 <br />~' `~ <br />` <br />~ <br /> / <br />~ <br />Address : <br />n p <br />f <br /> ~~~ ( <br />~ <br />City/StZp: IN V l <br /> Contact <br />Phone~e <br />~ , <br />ptNS ID: <br />Sample locatiore <br />_~ Address: <br />rrp: <br />II Colieded:I I~ 1/' I} I`j ~I f Time:) I~; 1 l1am. <br />mordh u~~uulrearu uhour min ^ P.m. <br />~~ ColleUed bY: I J Ma6bc: <br />l ^ Surface wa0er <br />^ Ground Water <br />^ Treated Water <br />Purpose : p Rartine ^ Spedai Purpose ^ Repeat <br />Chlorine residual: ~a ^ ^ MGIL Temp., Water. ^ ^ F <br />Commerks: <br /> TEST ORDER (Che ck appropriate box) : ~ <br />CHEMISTRY- INORGANIC I CHEMISTRY- ORGANIC RADIOCHEMISTRY <br />^ AflwGnity, PhenWpMhakin ^ Molybdenum ~ ^ Carbamates (] Alphal8eta, Gross <br />^ Alkalin~y,TOfal <br />O AWminum ^ Nickel ~ <br />^ Nrbogen, Ammonia Dst r, J' VOC ~ <br />^ THM ~~ 'um <br />^ AnfinanY O Nitrogen. Kleklahl ^ B mma Screen <br />^ Arsenic ^ Nitogen, Totai~ ^ DI T <br />' Gamma Spectrometry, <br />' <br />D <br />^ Barium ^ N'NatdNitrite ^ Nud <br />rde Specfic <br />p Beryllium ^ Nitri,~ ^ SV ^ Leak Test <br />p BOD ^ pH ^ Pesticides D Plutonium <br />^ Boron ^ Pfosphate, Ortlw D Gtyphosate ^ Radium 226 <br />^ Cadmium p Phosphate, Total ^ Flerbicides D Radium 228 <br />^ Calcium ^ Potassium ^ EDBlDBCP ^.Radon <br />^ Chbrxle ^ Selenium ~ D PCB ^ Ttwrium <br />C Chkrcine, total residual <br />^ SAicon (siliptes) ^ TOC ^ Tritium <br />^ Chromium ^ DRO ^ Other. <br />^ Conductively ^ Sfi~er O HEM (Orl Grease) ^ Other. <br /> <br />Copper ^ Sodkrm [] Other. <br />' remM temp.) <br />b ^ So6ds, Dissolved ^ Other <br />MICROBIOLOGY <br />Cyanide, Dist <br />b sofas, suspended <br />Fluo e C Solids, Total p Total Coliforrns, PA <br />^ Hardness, total ^ Solfafe Phase 1,2,5 -ANALYSES ^ Total Cotifomu, MTF <br />D Iron ^ ThaAium ~ p Heterotrophic Plate Count~,,~ <br />L Lead D Uranium p Organic (SOC / VOC) p Pseudomonas MPN t;? <br />G Magnesium ^ Zinc D Inorganic ^ E. CoG., MPN <br />^ Manganese O Other. ^ Other. <br />a <br />D Memory Q Other: ~ ^ Other. ~, i <br /> <br />, _, <br /> <br />i.I <br />fir <br />4~ <br />F7 <br />RapertR50ReC. Rw 11ALB9 <br />