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<br />(3 System ID INO-2007005541 <br />Collection Date 11/1/2007 820:OOAM <br />Control Number 202 <br /> <br /> <br /> <br />• ~ <br />• <br />~ <br />~ `-+uuu <br />~ ~ ~ <br /> <br />- Customerl0 1 <br />i 1 Colleded: / (~ ' / ~ © Time: ~ I~ _~ ~am. <br />F- <br />: df; <br />i rr-orrtlr <br />day year I~/J <br />hour min ^p.m. <br />1. Add . <br />~a~ 3 ~ M <br />'}" F-ir ~ ' af.~ Collected by: Ma w <br />:~ ~~~' -~p11,~15"~ ~O ~-O~ <br /> Contact: ^ Surface Water <br /> <br />~ Phone : <br />~ 3~ ~~6- ~~~~` ~ end Water <br />^ Treated Water <br /> <br /> <br />Pws lo: ,~ <br />i + <br />I ~ <br /> .-. Purpose : ^ Ror rtine ^ Spedal Pu rpose ^ Repeat <br /> Sample lACation: St7 ~ (' /~~ ~ <br /> <br />. <br />per; . <br />Chlorine residual: <br />as <br />a ~ MGJ~ <br />TemPM ~te~ ^ ^ F <br />x ~ <br /> Address: ~ Commerrts: <br />/ Cdy. ~ ~~ <br />TEST ORDER (Chec k appropriate box) : ~ <br />CHEMISTRY -INORGANIC CHEMISTRY -ORGANIC RADIOCHEMISTRY <br />^ Alkarinity, Phenolphthalein ^ Molybdenum ^ Carbamates ^ AlphaJBeta, Gross <br />^ Adcafmfiy, Total ^ Nickel ^ VOC ^ Americium <br />^ Akuninum ^ Nitrogen, Ammonia Dist. ^ THM ^ Carbon-14 <br />^ Antimony ^ Nitrogen, ICeldahl ^ BTEX ^ Gamma Screen <br />O Arsenic ^ 'Nitrogen, Total• ^ DiQUAT Gamma Spectrometry, <br />^ <br />^ Barium ^ N'dratelNitrite ^ SOC Nud~de Specific <br />O ~Ml+~ ^ Nitrite ^ svoc <br />^ Leak Test <br />^ BOD ^ pH ^ Pestiades ^ Plutonium <br />^ ~~ ^ Phosphate, Ortho ^ Glyphosate ^ Radium 226 <br />^ Cadmium ^ Phosphate, Total ^ Herbiades ^ Radium 228 <br />^ Caktium ^ Potassium p EDB/DBCP ^ .Radon <br />^ Chbride ^ Selenium p PCB ^ Thorium <br />^ Chkxine, total residual O Silicon (silicates) ^ TOC ^ Tritium <br />^ Chromium ^ DRO ^ Other. <br />^ Conducfivity ^ Srlver ^ HEM (Oil Grease) <br />^ Other. <br />^ Sodium <br />^ Copper ^ Other <br />^ COrrosivdy (reCOtd temp.) ^ Solds, Dissolved ^ Other. <br />MICROBIOLOGY <br /> <br />d Sords, suspended <br />C snide, Dist ~Aa1 <br />^ Fluoride "-Y ^ ~~, Total ^ Total Corifomu, PA <br />^ Hardness, total ^ Sulfate Phase 7,2,5 -ANALYSES ^ Total Cordorms, MTF <br />^ Iron ^ Thamum ^ Heterotrophic Plate Count <br />L Lead ^ Oranium ^ Orgariic (SOC / VOC) ^ Pseudomonas MPN <br />~~~ <br />^ M nesium ^ Zinc <br />a9 rg <br />^ Ino ank % <br />^ E. Coll., MPN <br />^ Manganese ^ Other: ^ Other. <br />[? Mercury ^ Other:_ ~ . Other. <br /> _~ t <br />~ ~. <br />~- <br />,;s <br />~~, <br /> <br />l_ARS Internet Address: http://www.cdphe.state.co.us/Ir/Ifiom.htm <br />Report f?SOReq, Rw 1ZOU99 <br />REQUEST F ~~ <br />