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OF?? <br />?? °?8 <br /> Colorado Department of Public Health and Environment <br />``•,?• <br />? 1876 t Compliance Assurance & Data Management Unit <br />colom& 6G'Q3IQ71Q t <br />of Publk Health <br />and Environment: REPORTING FORM FOR INORGANIC CHEMICALS ANALN'SES <br />SAMI'LER: FILL OU I ONE FORNI - FOR EACH INDI\'IDL!AL SAMPLINGPOINT or CONIPOSI f E SET <br />Are these results to be U.Se(i to fulfill Compliance 11) tori r eyuirentelntS? 1 ESgor NO ? <br />Is this a check or contirnrttion sample'' ? YES NO 7P <br />1'\\-Slllr:a?r??X38 COUNTY: ?k411I/5-2A_ UATECOLLECTED: <br />SYSTEM ESTABLISIIMENl NAME: W <br />SYSTEM MAILING ADDRESS: <br />A-dy <br />addre.y Box?- ` CITY STATE ZIP <br />CONTACT PERSON: Stria ,L" atL? PI IONS: 'C/•F1J ?[J) 9aQ9 -a 8 <br />SAMPLE COLLECTED BY: TINIL COLLECTED: % •'?_(` pm 'af WATER TYPE: RA10 ,?,,;t,ti „ „r,.t.. r:_xxx. ? Cl ILORINA fEll 011IER TREATMENT121111 941 <br />SAMPLE POINT: LOCATION: Address SOURCE(S) REPRESENTF? COX LPL. <br />EPTDS J ?D 7" I C(.C/Ui4/??l?ll? (?G1G3?1 N? /l r!! ? <br />DO .S.,k?IPLES NEEI)'I.O BE CO?IPOSI"I'EI) Bl"i'HE L:1BOR:%7.OR't'? YES[] NO fR-',- <br />CHECK OR CONFIRMATION SAMPLES CANNOT BE C0.v7POSI•rEI) / <br />For Luhurcnorr Use On& Below Thi.? Lin <br />LABORATORY SAMPLE- CLIENT NAME or Ill- <br />LABORATORY NAME LAB PHONE DATE RECEIVED IN LABORATORY DATE ANALYZED- <br />COMMENTS: <br />PARAMETER RESULT in <br />(m /L MCL in <br />m /L) STANDARD <br />METHOD Lab MDL in <br />m /L <br />COPPER ?. 1.3* ttro 3/1 <br />LEAD 0.015* !?( 35cv .?(/?8 ?6 , bD o?- <br />8DL - Indicames that the compound was analyzed for, but was below the Lab MDL <br />NT- Not Tested for Compound <br />mg/L = Milligrams per Liter <br />MCL = Maximum Contaminant Level <br />H= Holding time has been exceeded <br />= Not and MCL, "Action Level" <br />Lab MDL = Laboratory Method Detection Limit <br />i <br />r <br />1/,/.z9ef " ?, L ,,- , . - I <br />Reviewe & Approved by Tit e Date <br />MAIL RESULTS TO: CDPHE. WQCD-CADM-B2, 4300 Cherry Creek Drive South, Denver, CO 80246-1530 <br />P'r c . ul 2