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- laboratory and Radiation Services Division <br />8100 Lowry Boulevard, Denver CO 80230928 <br />' .x US Mail: PO Box 17123, Denver CO 80217 <br />lKr (303) 692-3090 fax (303) 344-9989 <br />a vaa~~a1 <br />REQUEST FOR ANALYTICAL SERVICES <br />CustomerlD ~-'w"".,,~-1~t,, ~p.. ~~[.. i,,~~~,v,~.C,.K..r~~,..,1«+`O ~1 <br />Name: a~711~k •~,l~t"~L-~~ <br />Address: ~'?J7,,3 ~sH~rnlt~st-1ZM- 2. Ur <br />Gtyrs~P: ~ ~~v.~~ C.t~ ~~3 <br />Contact <br />I,E PWStD: <br />tl <br />o. <br />Sample location: <br />Description: - n .nP_.M ~ .b ~ . ~P~4-~e~ <br />Address: l_..~ `(G- 7Y) - ~ <br />~'~~ ~( C;t~12 ~ CC ~~ 7~rl~t4i-- <br />caleaan No: <br />Colleded:h ~}.f, ~/~/~~~1i/{~ ~ ~ Time: ~~Q~.~~T!/~$m. <br />month day yeC~ ^Lar 1 hams miinv ~ <br />Cdleded by. ~ Matra: <br />Surface Water <br />^ nd Water <br />^ Treated Water <br />Purpose : routine ^ Special Purpose ^ Repeat I~I <br />Chlorine residual: ~n ^^ MGIL Temp., Water: ~ I P <br />CommerRS: <br />TEST ORDER (Check appropriate box) : ~ <br />CHEMISTRY-INORGANIC I CHEMISTRY- ORGANIC RADIOCHEMISTRY <br />^ AtlcaQnrty, Phenolphthalein ^ Moybdenum ~ ^ Carbamates ^ AlphalBefa, Gross <br />^ Alkafmi;yr, Total ^ N'rdcel I ^ VOC ^ Ameridum <br />^ Aluminum ^ Nitrogen. Ammonia Dist ~ C THM ^ Carbon-14 <br />^ Antimony ^ Nitrogen, IGeldaht ^ BTDt ^ Gamma Screen <br />^ Arsenic ^ Nitrogen. ToW ~ ^ DIOUAT Gamma Spedrometry, <br />^ Barium ^ NitrateMBrite ^ SOC ^ Nudide Specific <br />^ Beryllium ^ NitriOe ^ SVOC ^ Leak Test <br />^ gpp ^ PN ^ Pestiddes ^ Plutonium <br />^ ~~ ^ Phosphate, Oruro ^ Glyphosate ^ Radium 226 <br />^ Cadmium ^ Phosphate, Total ^ Herbiades ^ Radium 228 <br />^ Cakdum ^ Potassium ^ EDB/DBCP ^.Radon <br />^ Chbride <br />^ Selenium ^ PCB ^ Thodum <br />^ Chtorirle, total residual ^ Silicon (silicates) ^ TOC ^ Tritium <br />^ Chromium ^ DRO I,] Other. <br />^ ~~~ ^ Silver r^ HF~1 (Oil Grease) ^ Other. <br />^ Copper O Sodium ^ Other <br />^ Solids, Dissolved <br />^ Corrosivity (re <br />cord temp.) <br />^ Other. MICROBIOLOGY <br />rr <br />Cyanide, Da~~'~\ ^ Solids, Suspended <br />^ Fluoride -JJ ^ Sdids. Total ^ Total Colifonns, PA <br />^ Hardness, total ^ Sulfate Phase 1,2,5- ANALYSES ^ Total Coliforms, MTF <br />^ Iron ^ Thallium ~ ^ He[erotrophic Plate Count <br />I~ Lead ^ Uranium I ^ Organic (SOC / VOC) ^ Pseudomonas MPN <br />^ Magnesium ^ Zine ^ Inorganic ^ E. Coli., MPN <br />I <br />^ Marganese ^ Other: ^ Other. <br />^ Meroury ^ Omer. , <br />, ^ Other. <br />LABS Internet Address: httpJ/www.cdphe.state.co.us/IrArhom.htm <br />Rerydr i25DRe¢ Rav 7?Ai199 <br />