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OF ?Lpp <br />' Colorado Department of Public Health and Environment <br />t ?`??- Compliance Assurance & Data Management Unit <br />Colorado o??, <br />of Public Health REPORTING FORM FOR INORGANIC CHEMICALS ANALYSES <br />and Environmear <br />SAMI'LER: FILL OUI ONE FORM - FOR EAC11 INDIVIDUAL SAMI'LING POINT or CONVOSI DE SE'f <br />Are these I-esultS to he used to fulfill colllpliance 1110111tOrln I-eChlIrC111el1tti? YES NO ? <br />Is this a cheek or eontirnintion sample'' © YES _JS?NO <br />P\1-SID r:.7!403 0° COUN IN': 0& I <br />?°?L(.?/?/ Tp?1 DA FE COLLECTED: I1 /?8 <br />'n!? / - <br />SYSTEM ESTABLISI INTENT NAME:__ - ? U/5 &ic, VIA- ine., <br />el SYSTEM MAILING ADDRESS: c1?w 6q i 'abi Q,?Sy-f 0 cta <br />Streit sdd-PO Box CITY /? STATE Zip <br />-- CONCACT I'LR_SON: - rJ.QJ _I'l IONE: (WD I `7o, //??q <br />SA1?91'LE COLLECTED BY: e,"KI k, 111`'IE LOLL FC DED: `7- pill <br />Ef' 11 <br />r- >> __ <br />WATER TYPE: ? CHLORINATED OTHER TREATMENT <br />Al M. <br />SAMPLE POINT: LOCATION: Address SOURCE(S) REPRESENT &U <br />EPTUS- ?4'-OG)GD I ???LUl?IIrJG? NIF <br />DO SAMPLES NEED TO BE CONIPOSITED BY THE LABORATORY" YES ? NO [K <br />CHECK OR CONFIRMATION SAMPLES CANNOT BE COMPOSI.1•ED <br />o For Luhorworv Use On!r f e/wi• This Line <br />LABORATORY SAA1}'LE _ 0C? - Q/?8? CLI/EyN I NA1?1E or Ill W /????j6 <br />LABORA1-ORY NAME 4,7f// /,p I'11ONE- (a) 4agn? CQ/,w <br />DATE RECEIVED IN LABORATORY DAVE ANALYZED <br />COMMENDS: <br />PARAMETER RESULT in <br />(m /L MCL in <br />m /L) STANDARD <br />METHOD Lab MDL in <br />m /L <br />COPPER 0.005 1.3* M .9150D <br />LEAD ZD& 0.015* 35oa JI!3?IP jf,00.2-. <br />BDL = Indicantes hat the compound was analyzed for, but was below the Lab MDL H= Holding time has been exceeded <br />NT- Not Tested for Compound * = Not and MCL, "Action Level" <br />mg/L = Milligrams Per Liter Lab MDL = Laboratory Method Detection Limit <br />MCL = Maximum Contaminant Level <br />f Li" <br />Reviewed & Approved by Tit e Date <br />MAIL RESULTS TO: CDPHE, WQCD-CADM-B2, 4300 Cherry Creek Drive South, Denver, CO 80246-1530 <br />