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.OF'? <br /> <br /> Colorado Department of Public Health and Environment <br /> <br />? f 876 ? <br /><k ?`? • Compliance Assurance & Data Management Unit <br />Colorado Deparmra t <br />of PublicHnlth REPORTING FORM FOR INORGANIC CHEMICALS ANALYSES <br />and Environment <br />SAMPLER: )-ILL OUT ONE FORM - 1-'OR LACII INDI\.IDL!AL SAMPLING POINT or COMPOSITE SE"f <br />Are these resultS 10 he used to fulfill compliance monllorin requirements? I LS or NO ? <br />IS this a check or confirmation sample? 0 YES [ NO <br />I'\VSIll r: a?? COUNTY: u?nr DATE COLLECTED: D?%l <br />SYSTEM ESTABLISHMENT NAME: <br />SYSTEM MAILING ADDR <br />W <br />Screw add,-PO Box CITY STATE ZB <br />-- CON 1.401 PEKSON: I'I IONE: t ??dl 9i? -da .3 <br />SAMPLE COLLLC]'ED BY: /1?j, H ME COLLEC I LD: m ?m p?j <br />WATER TYPE: RAW ,n,,:I,w. „ ,.I„7,,;,,,,,;,,,: ? CI ILORI NATEll01' OTHER TREATMENT // o` <br />SAMPLE POINT. LOCATION. Address SOURCE(S) REPRESENX I *a, <br />Ell1-llS- S 1P - 00 I i' `)(P k- r I rea p(Q?d 6a nn,(, <br />DO SAMPLES NEED TO BE CONIPOSITED BY THE LABORATORY? YES ? NO f? <br />CHECK OR CON F1RMATION S%.1IPLES CANNOT BE COM POSITED <br />For Luhm-cuo't' USe Only Belo Ibis Line <br />LABORATORY SAMPLE CLIENT NAMEnor Ill1 ?? . <br />LABORA TORY NAME 611/10 CftVn??LI J?i?,f!rr2Y LAB Pl1oNE ;(q <br />?l nO? ?o1 `?o? 5s <br />DATE RECEIVED IN LABORATORY Cli'i/-Or llACEANALI'LEll <br />CONINIEN I'S: <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* ?D ,U E?Ccs <br />LEAD L 0.015- &D 1?' .00 2- <br />BDL - Indicantes 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 /> <br />MAIL RESULTS TO: CDPHE, WQCD-CADM-B2, 4300 Cherry Creek Drive South, Denver, CO 80246-1530 <br />P rvc . of 2