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~. <br />.,~ <br />~ -r~ x~~n <br />~~ <br />Laboratory and Radiation Service <br />8100 Lowry Boulevard, Denver CC <br />US Mail: PO'Box 17123, Denver C <br />(303) 692-3090 fax (303) 344-99f <br /> <br />System ID .INp_2008001242 <br />Collection Date 3;27,2008 10:00:00AM <br />Control Number 401 <br />REQUEST FOR ANALYTICAL SE <br />~ ~ <br />.: <br />Customeri0 <br />City/st?p: ;~ ~ ~ ~ ~ ~--'r--lr \ ~~ ~ U~P-~,t- ~c <br />Contact L~.~, ~--j C,,,j ~~.p~ <br />Pfione~3) Q~ -'rA,~~ <br />PWS ID: <br />Sample Location: <br />t1 <br />~~ <br />/ Cdy. <br />St: Zip: <br />Collected: <br />rime: ~) ~'~ ~'~., <br />month d'y years ~Lihour .1 • min ~ O F-m. <br />Collected by: Matmc: <br />^ Surface Water <br />^ Ground Water <br />^ Treated Water <br />Purpose : ^ Routine ^ Spedal Purpose ^ Repeat ~ <br />Chlorine residual: t____I r, ~ ~ MG/L Temp.,lNater: ^ I I p <br />Comments: ~L-J- <br />TEST ORDER (Chec k appropriate box) : ~ <br />CHEMISTRY- INORGANIC CHEMISTRY- ORGANIC RADIOCHEM/STRY <br />p Alkalinity, Phenolphthalein ^ Molybdenum ~ ^ ~~~~ <br />^ Alpha/Beta, Gross <br />p Alkalinity, Total ^ Nickel D VOC ^ Americium . <br />^ Aluminum ^ Nitrogen, Ammonia Dist. ^ THM ^ Carbon-14 <br />^ Antunony ^ Nitrogen, Kleklahl ^ BTEX ^ Gamma Screen <br />^ Arsenic O Nitrogen, Total ^ DIQUAT Gamma Spectrometry, <br />^ Barium ^ N'itrate/Nitrite <br />~~, ~~ <br />^ ODllium ~ ~ ~ ~ ~ ~ ^ SOC <br />^ SVOC ~ NuGide Specific <br /> <br />p Leak Test <br />~ <br />^ ^ Pesticides ^ Plutonium <br />^ Boron ^ Phosphate, Ortho ^ Gyphosate ^ Radium 226 <br />^ Cadmium ^ phosphate, Total ^ Herbiddes ^ Radium 228 <br />^ Calcium ^ potassium ^ EDB/DBCP ^ ,Radon <br />D Chionde ^ Selenium ^ PCB ^ Thorium <br />^ Chlorine, total residual ^ Silicon (silicates) ^ TOC ^ Tritium <br />^ Chromium ^ DRO ^ Other. <br />^ ~~u~.~y ^ Sitver ^ HEM (Oil Grease) ^ Other. <br />D Copper ^ Sodium ^ Other. <br />^ C~~o .(~ tip) ^ Solids, Dissohred <br />b Solids <br />Sus <br />ended ^ ~r <br />MICROBIOLOGY <br />, <br />p <br />Q, _C Hide Dist <br />~ <br />D Solids, Total <br />^ Fluoride <br />p Total Colifomu, PA <br />D Hardness, total ^ Sulfate Phase 1,2,5 -ANALYSES D Total Colifonns, MTF <br />^ Iron ^ Thallium ^ Heterotrophic Plate Count <br />L Lead ^ Uranium ^ Organic (SOC / VOC) ^ Pseudomonas MPN <br />^ Magnesium ^ Zinc D Inorganic p E. Coll., MPN <br />^ Manganese ^ Othec O Other. <br />[; Mercury Q Other. , ~ f~ Other. -n <br />• 7D <br /> mo <br /> I .] <br />w <br />"C~ <br />3 <br />LARS Internet Address: http://www.cdphe:state.co.us/Ir/Ifiom.htm <br />Reporr ~soReq, rta~ 12~Ot/99 <br />C,?.- <br />;: <br /> <br />t~ <br />