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-~ ~ - Laboratory and Radiation Services Division <br />' 8100 Lowry Boulevard, Denver CO 80230-f <br />US Mail: PO'Box 17123, Denver CO 80217 <br />~n~aKrr (303j 692-3090 fax (303j 344-9989 <br />... <br />REQUEST FOR ANALYTICAL SERVICE <br />6' r- <br />System ID 1N0-2008001245 <br />Collection Date 3/27.2008 9:30:OOAM <br />Control Number 404 <br />~. • - ~ - . - <br />Custon,erl0 ~ Collected: / / ~ ® Tme: e . 3 ~ "'. <br />'~" Name : r, ' month day year irorx mJn ^ P.m. <br />Address : ~~ t 3 g)"I Collected by: Matmc <br />Contact CS A A~,`~ ~ ~U~" ~ p SGruo~unced wa~ <br />Photo ~ J Z~e~ ~-~~ ~ ~ ^ Treated Water <br />~ • ~ <br />i~ <br />PWS 10: puke ; ^ Routine ^ Speaal Purpose ^ Repeat <br />sample Location: Lott a <br />Cidorine residual: ~. a a MGIL Temp., Water. ~ ^ F <br />/~~: Comments: <br />/ Cdy: ~ ~' <br /> TEST ORDER (Che ck appropriate box) : ~ <br />CHEMISTRY- INORGANIC CHEMISTRY- ORGANIC RADIOCHEMISTRY <br />^ ANcaGnity, Phenolphthalein ^ Moybdenum O Carbama~s ^ AlphalBeta, Gross <br />^ Alkalinity, Total ^ Nickel ^ VOC ^ Americium <br />^ Alumatum ^ Nitrogen, ~ Dist. ^ THM p Carbon-14 <br />^ Antrnwny ^ Nitrogen, Kleldahl ^ BTEX ^ Gamma Screen <br />^ Arsenic ^ Nitrogen, Total• <br />~ ^ OIt2UAT <br />~ Gamma Spec3rometry, <br />^ <br />^ Bay ^ Nitrate/Nitrite ~ ^ SOC Nudde Specific <br />^ Berytliurn ^ N'drata ~ ~ SVOC ^ Leak Test <br />^ BOD ^ pH ~ ^ Plutonium <br />^ moron ^ Phosphate, Ortho ^ GhrP~te p Radium 226 <br />^ Cadmium.. ^ Phosphate, Total ^ Herbicides- ^ Radium 228 <br />^ Caldum ^ Potassium ^ EDBJDBCP ^ .Radon <br />^ Chkxide ^ Selenium ^ PCt3 ^ Thorium <br />^ Chkxine, total residual ^ SAicon (silicates) O TOC ^ Tritium <br />^ Chromium p DRO ^ Other. <br /> <br />^ Conductivity ^ Srlver <br /> <br />' HEM (Orr Grease) <br />O <br />^ Other. <br /> <br />r ^ Sod <br />arm Other- <br />~ gyp.) <br />^ Comos ^ Solids, DissoMed ^ other. MICROBIOLOGY <br />snide Dist. ~ d Solids, Suspended <br />Fluoride D Solids, Total ^ Total CoGforrtrs, PA <br />O Hardness, total ^ Sulfate Phase 1,2,5 -ANALYSES ^ Total Cofiforms, MTF <br />^ Iron ^ Thalfium ~ ^ Heterotrophic Plate Count <br />Lead ^ Uranium ^ Organic (SOC / VOC) ^ Pseudomonas MPN <br />^ Magnesium ^ Zinc ^ Inorganic ^ E. Cori., MPN <br />^ Manganese ^ Other: ^ Other. <br />[.,-+ Mercury ^ Other: ~ . ^ Other. <br /> .t <br /> <br /> <br />rJ <br />-.] <br />O <br />3 <br />LARS Internet Address: httpJ/www.cdphe.state.co.us/Ir/Ifiom.htm ~ r..r <br />--~~ t+25dRey, Rw 1?iotN9 E.+ <br />- -""' . <br />