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Laboratory and Radiation Services Division <br />•• 8100 Lowry Boulevard_DenveLCn~~~-~^°°-- <br />•~.rt• us Mail: ~ s Stem ID INO-2004004011 <br />~~ (303)692 Y <br />,,,aE,rv;,a,,,,m, Collection Date 9/16/2004 10~.00:00AM <br />Control Number <br />REQUEST FOR ~ <br /> <br /> t <br />A <br />4 0 <br />t~ <br />L~ <br />~ <br />S ~ <br />~ <br />~ <br />l <br />CustomedD ~ t ~(~( <br />O <br />L <br />S IleUed: / L / I /~© <br />~ <br />Iv Time. IQ II,'~ I ~ ~ ~ I ~ I ^ am. <br />J iv <br />i <br />IIJ <br />L <br />'1" ~ <br />,~ <br />, <br />` <br />~ <br />~ <br />/ <br />Il <br />~y <br />~ <br />/' <br />~ <br />• l <br />Name:a(~'C~!'\`~. ``C.r `c-u!-W`~v <br />c_~ <br />Address: ar <br />ye <br />mWitll daY m <br />~u <br />r <br />in ^P.m. <br /> ~ <br />~~~35~'~~IVI~ J\ ~~~v Colleted by: Mafr uc: <br /> L~J <br /> ~ <br />~ ~`(~ <br /> Contact <br />Phone ~3// ~ ~ o'~~ 1.~~ O 1 <br />S~ ~ Ground Water <br />^ Treated Water <br />~ • • <br /> r-~ <br />PWS 10: ~- ~ ~ i C <br /> <br />P <br />` <br /> ~ <br />"4 <br />t~ I <br />~ urpose . , p <br />i Routine ^ Special Pu <br />`~ rpose ^ Repeat <br /> D <br />~~ ~ <br />Sample iACation: 1 ~ <br />y~~~).1J f \ SI~ <br />Descriptbn: Chlorine residual: ~ a ^ ^ MGlL Temp., Water. ^~ F <br />x <br />g Address: Comments: <br /> City; St Zip: <br /> <br />TEST ORDER (Cheek appropriate box) : ~ <br />CHEMISTRY- INORGANIC ~ CHEMISTRY- ORGANIC RADIOCHEMISTRY <br />^ Alkalinity, Phenolphthalein ^ Molybdenum I ^ Carbamates ^ Alpha/Beta, Gross <br />^ Alkalinity, Total ^ Nickel ~ ^ VOC ~ ^ Americium . <br />^ Aluminum ^ Nibogen, Ammonia Dist. ^ THM ^ Cad~on-14 <br />^ Antimony ^ Nitrogen, IGeldahl ^ BTEX - ^ Gamma Screen <br />^ Arsenic ^ Nitrogen, Total ^ DIQUAT Gamma Spectrometry, <br />^ Barium ^ Nitrate/Nddte ^ SOC ^ NuGide Specfic <br />^ Beryllium ^ Nitrite ^ SV~ ^ Leak Test <br />^ gpp~ ^ PH ^ Pesticides ^ Plutonium <br />^ Boron ^ Phosphate, Ortho ^ Gtyphosate ^ Radium 226 <br />^ Cadmium ^ phosphate, Total ^ Herbicides ^ Radium 228 <br />^ Calcium ^ potassium ^ EDBIDBCP ^.Radon <br />^ Chbride ^ Selenium ^ pC8 ^ 7twnum <br />^ Chlorine, total residual <br />^ Silicon (silicates) ^ T~ ^ Tritium <br />^ Chromium I ^ DRO ^ Other. <br />^ Condudiv'rty ^ Srlver ^ HEM (Oil Grease) <br />^ Other. <br />I <br />^ Sodium <br />^ Copper ^ Other. <br />rrosiv' ~ ^ Solids, Dissolved ^ Other. MICROBIOLOGY <br />Cyanide, Dist ~~ ^ Solids, SuspeMed <br />uo e ^ Solids, Total ^ Total Colifonns, PA <br />^ Hardness, total ^ Sulfate phase 1,2,5 -ANALYSES ^ Total Colifomu, MTF <br />^ Iron ^ Thallium ~ ^ Heterotrophic Plate Count <br />^ Lead ~^ Urenium f ^ Organic (SOC/VOC)~ ^ Pseudomonas MPN <br />^ Magnesium ^ Zinc ^ Inorganic ~; ^ E. Coll., MPN <br />I <br />^ Manganese C Other: 09 ^ Other. <br />_n, Mercury ^ Other. ~ ^ Other. <br /> T <br />I r• t ~ <br /> <br /> <br />Rppr tL'OReq, Rev 1?A199 <br /> <br />