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i~ <br /> <br /> Laboratory and Radiation Services Division <br />~^ . 8100 Lowry Boulevard, Denver CO 80230-6S28 <br />:,~- US Mail: PO 8oz 17123, Denver CO 80217 <br />ca~o~~ (303) 692x090 faz (303J 3~M--9989 <br />,rn,su xere <br />.c E.a,a.m <br />REQUEST FOR.ANALYTICAL SERVICES <br />system ID ORG-2003000016 <br />Co1)ecfionDate g~6~2003 ZcI5:00PM <br />Control Number I <br />Cdfectiari No: <br />CustomertD ~ U Coifeded: h / ~ 6 / Q ! rune: I Q' ' ~ t S ~ m. <br />Name : ~ ~ ~ ~~-lCx'~ c.-c~C- u I • ; i . p.m. <br />~/~ l_.- __-.~_- - _--month-Gay__yeac-~.~o¢f _1n(n--_ <br />Address : ZC~(O F (o ~ l v~ ~,'rY z~'Z I~' cone~a er i ~~ i -~~,ti - i Mac;:: ~ L,~ c,~-,.,1' - <br />Ciiy/StlLo--rf. _ _ _.'..~^ ~ ~rfl'Z33 + <br />Contact: MD/~~ ~-(pl t2.v~ ~ Surface Water <br />Phone: ~-3_L{S~j-~(Co ~~ I L~ Ground Water <br />y,( ^ Treated Water <br />Dc you wish resultr Faxed b you? Yes ^No ~. !f -Yes- provide your <br />dedicated Faz C _- _ _ _. Initials _ ~ . <br />PWS lD: ?! i t I I I I I I I~ <br />. ~ ~7~I ~ to ~ urpose ; ~ Roudne [J Spedal Purpose Repeat <br />iample l.omtiort: ~ ~J~C ~~~ ~~~^ ~ _ _ <br />Desaiptron: ~~ ~.~IUQ< ~ Chlorine residual: ~ ~~ MGR- Temp., Water. i II ~ F <br />Address: t'1j`G~ryV ~-C- G2ti~ "ui~~~(' moments: ©CSci~c.~-v,..K S~~~g~~~. <br />aty:',,t1~r,,,vls(~,,;.(~se Co zp: X233 <br /> TEST ORDER (Check appropriate box) <br />Ci-fEM1STRY-fNORC,kN1C I CNe%7STRY-ORC-kNIC ( RADiOCHEMfSTRY <br />[] AJkaliniiy. PhenolphtFalein ^ Molybdenum I ^ Carbamates I ~ AJPhalSefa, Gross <br />.^, Nkafinity, Total ^ Nickel ( ^ VOC j ^ Ameridum <br />.'! Aluminum C Nitrogen, Ammonia Dirt I ^ 7}iM ^ Carbmt-74 <br />Antimony C Nitrc~en, Keldahl i r 81'EC C Gamma Screen <br />Arsenic G Nitrogen, Total ^ DIQUAT Gamma Spectrometry, <br />'= Barium ^ MtrateMitrite ~ ^ SOC G Nudide Spedfic <br />BeryGium ~ ~ Nitrite C SVOC ^ Leak Test <br />^ BOD O pH , O Pesaddes p Pturonium <br />C Bmrn Q Phosphate. Oriho ^ Giyphosate ^ Radum 226 <br />~ Cadmium <br />^ Phosphate. Total ~ Fierbiddes ^ Radium 728 <br />Cdr..um ^ Potassium ^ ED8/DBCP ^ Radon <br />^. C1lodde O SeleniUJ77 <br />~ ^ PCS (~ Thorium <br />,` Chlor4le, total residual ~ <br />L STmn (silicates) I ^ TOC - <br /> <br />~ ^ Tritium <br />:-~.. Chromium ^ DRO ^ OQier. <br />_ Conductivity ~ D Silver I C HEM (OG -Grease) C Other. <br /> <br />- ~~ G Sodum I ~ Other. D r r~ P. <br /> <br />._ _ <br />~~ I .r_{. Solids. Oissclved <br />__ _.~_ _ <br />___~~er.________ __ <br />-_ <br />M7CROBlOLOGY <br />._.. Cyanide, Dist ^ SoGds, Suspended ~ I <br />~- Fluodde ^ So(ds, TOGI I p Total CaGtorms, PA <br />Hardness, total G Sulfate ! phase 1,1,5 -ANALYSES I O Total Cofdorms, MTF <br />• -~ Iron ~ 7halGum ~ ~ ^ Heterotroptuc Plate Count <br />.Lead ~ ^ Uranium C Organic (SOC! VOC) I ^ Pseudomorras MPN <br />C Magnesium - ^ Lnc C InorSp;nic ~ I ^ E. Cot., MPN <br />Manganese' C Other. C Other. <br />Mercary C Other. I C Other. <br />Rqm x'SOPeR, Rw GJn rN] <br />L. <br />