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~!` ,; _ Laboratory and Radiation Services Division <br />• 8100 Lowry Boulevard, Denver CO 80230-fi92g <br />` • US Mail: PO'Box 17123, Denver CO 80217 <br />c ~~K (303) 692-3090 fax (303) 344-9989 <br />~~ G <br />REQUEST FO ANA I AL SERVICES <br />.~ <br />Custonlerio <br />A~ress : l'St 3 SK f,~.M It~C S"t' Rn1 cat; <br />contact: S7tV-'t br J/t`S ~'~ct /~` .-~ ^~ <br />Phone:~3f~3J ~~6~ Tti /~' <br />~ . • <br />~ Ala: C ~~i ~nn~ <br />Sample location: ~~~~ ~~ C[~. ~~ <br />~ Address: [-G. l( [,..~.~ fiD 1 <br />System ID <br />Collection Date <br />Control Number <br />caleCtlorl No: <br />INO-2008000179 <br />1 /9/2008 9: 40:OOAM <br />100 <br />~ Colteded: I Tl~i/I s~ll4 i!)/~ IU rime. ~~C'/ ~ •~ (I~I~,~ ~am: <br />~ ~~ ~~.J LV I L_.iJ LU Ls.d ~~ <br />Collected bY: Matrioc <br />^ surface water <br />^ Ground water <br />^ Treated Water <br />Purpose : (r outine ^ Special Purpose ^ Repeat <br />Chlorine residual: ~ a a D MGJL Temp., water, a ^ F <br />Comments: <br />TEST ORDER (Check appropriate box) : ~ <br />CHEMISTRY-INORGANIC CHEMISTRY- ORGANIC RADIOCHEMISTRY <br />^ Alkalinity, Phenolphthalein ^ Molybdenum ^ Carbamates <br />^ Alkalmity, Total ^ Nickel ^ Alpha/Beta, Gross <br />rJ VOC ^ Americium <br />^ Akrminum ^ Nitrogen, Ammonia Dist ^ THM 14 <br />^ Antrnwny ^ Nitrogen, Kleldahl ^ BTEX ` a Screen <br />^ Arsenic ^ Nitrogen, Total ^ DIQUAT <br />^ Barium ^ NitratelNitrite ^ SOC ~~ Nud~ide Specdi~~ c cep. <br />^ Beryniurrr ^ NitM,te ^ SVOC <br />^ BOD ^ leak Test <br />^ PH ^ Pesticides ^ Plutonium <br />^ Boron ^ Phosptate, Ortho ^ GNP~te O Radium 226 <br />^ Cadmium ^ Phosphate, Total ^ hlerbicides ^ Radium 228 <br />^ Chbride ^ Potassium ^ ~~~' ^ .Radon <br />O Selenium ^ ^ Thorium <br />^ Chkxine, total residual ^ Silicon (silicates) ^ TOC ^ Tritium <br />^ Chromium ^ DRO ^ Other. <br />^Conductivity ^ Silver ^ HEM (Op Grease) <br />^ Other. <br />^ Copper ^ Sodium ^ Other . <br />Corrosiv' record temp.) ^ Solids, Dissolved ^ Other. <br />d solids, suspended MICROBIOLOGY <br />^ Cyanide, Dist (~ <br />u ^ Solids, Total ^ Total Colrfonns, PA <br />^ Hardness, total ~ Sulfate Phase l,2,5 -ANALYSES ^ Total Colifonns, MTF <br />^ Iron ^ Thallium ^ Heterotrophic Plate Count <br />L Lead ^ Uranium ^ Organic (SOC / VOC) ^ Pseudomonas MPN r~, <br />^ Magnesium ^ Zinc ^ Inorganic ^ E. Coli., MPN ~ <br />^ Manganese ^ Other: ^ Other: ~° <br />~? Mercury ^ Other. ~ <br />f_7 Other. ,~ <br />' ~ <br />i ~• <br />G~ t~tl~~g <br />LARS Internet Address: http://www.cdphe.state.co.us/Idlfiom.htm ~ ~ ,~ 5--~ <br />Report f250Req, Rsv 1201/99 1 <br /> <br />