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Laboratory and Radiation Services Division System ID 1NO-2008001913 <br />8100 Lowry Boulevard, Denver CO 80230-64 Collection Date 5/6,-2008 1:00:00PM <br />US Mail: PO Box 17123, Denver CO 80217 Control Number 18 <br />A*- <br />o(303) 692-3090 fax (303) 344-9989 <br />REQUEST FOR ALYTICAL SERVICES wie Lion No: W nn Fa I(9- F?[I <br />customertoar I. P 0 C UPS <br />J r . <br />Naive : <br />Address : <br />city/SUZip: V ?„ (C i??` ui s <br />contact- ?ny WG?t??w?/ FJ?'r1n4? ?C¢54-A <br />PM 10: <br />Q. <br />Sample Location: <br />Description: 1h-W75s-sci ?G <br />city: St: zip: <br />Collected: 10 115-11/1 U,\ [W/M19 U T <br />month day year <br />Collected by " Q Matibc <br />hour min 016'"' <br />Surface Water <br />? Ground Water <br />? Treated Water <br />Purpose : ? Routine 21rppecial Purpose ? Repeat <br />Chlorine residual: D r n ? MGdL Temp- Water. <br />? ? F <br />Comments: E A,?.. Rio t_l o Z `, <br />TEST ORDER (Che ck appropriate box) <br />CHEMISTRY- INORGANIC CHEMISTRY- ORGANIC RADIOCHEMISTRY <br />? Alkalinity, Phenolphthalein VMOlybdenum <br />- - ? Carbamates _ ha/Beta, Gross <br />? Alkalinity, Total [+rNiickel ? VOC t ericium <br />12'Akuninum ? Nitrogen, Ammonia Dist. ? THM bon-14 <br />? Antimony ? Nitrogen, ICleldshl ? BTEX nma Screen <br />Arsenic ? Nitrogen, Total' ? DIQUAT mina Spectrometry, <br />? Barium ? Nitrate/Nitrite ? SOC a jpecific <br />? Beryllium ? Nitrite ? SVOC ? Leak Test <br />? BOD - CpllH ? Pesticides r0-1 Plutonium <br />? Boron ? Phosphate, Ortho ? Glyphosate ? Radium 226 <br />? Cadmium ? Phosphate, Total ? Herbicides ? Radium 228 <br />? Calcium ? Potassium ? EDB/DBCP ? .Radon <br />? Chloride ? Selenium ? PCB ? Thorium <br />? Chlorine, total residual ? Silicon (silicates) ? TOC ? Tritium <br />? Chromium ? DRO ? Other. <br />[Conductivity ? Silver ? HEM (0-1 Grease) ? Other. <br />,/ <br />UrrCoppef ? Sodium <br />? Other_ <br />0 Corrosivity (record temp.) ? Solids, Dissolved ? Other <br />MICROBIOLOGY <br /> <br />t3 Solids, Suspended <br />? Cyanide, Dist. <br />? Fluoride 0 Solids, Total <br />a Sulfate ? Total Colifomns, PA <br />MTF <br />lif <br />? Hardness, total y Phase 1,2,6jrli"ESi omms, <br />ia00 Total Co <br />l;'fron ? Thalfium ? Heterotrophic Plate Count <br />Uranium <br />q ead ? ? Organic (SOC / VOC) ? Pseudomonas MPN <br />_/ <br />? Magnesium V zinc ? Inorganic ? E. Coti.. MPN <br />Manganese ? Other ? Other <br />V 'Mercury ? Other: ? Other. <br /> <br />?ARS Internet Address: http://www.cdphe.state.co.usAr/lrhom.htm ` U IU <br />VW 02WRM Rev 12MM