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Labc ato y and Radiation Services Division <br />8100 Lowry Boulevard, Denver CO 80230-6928 <br />e US Mail: PO Box 17123, Denver CO 80217 <br />cw--b (303) 692-3090 fax (303) 3449989 <br />err?wK ? <br />*W Eevk0rAW [ <br />REQUEST FOR ANAL AL SERVICES <br />CUSTOMER <br />customerl0 <br />Name : <br />Address : 3 l 3 'S t.- ?- <br />CKY/St/rp: DM -. -e? <br />Contact <br />-? <br />Phone : W-3 <br />• Mr <br />System ID 1NO-2008002824 <br />Collection Date 7/17/2008 9:00:OOAM <br />Control Number 31 <br />Collection No: <br />Collected: I d I/i `1 l /1 Q f? Tn1e: LJ' I J;?(?II '". <br />month day ?I? L year ho(w L?mlin <br />Collected by: Maw V <br />? Surface Water <br />? Ground Water <br />? Treated Water <br />PWS 10: ' I I ' ? ' uI U 1 1 Purpose : ? Routine ? Special Purpose ? Repeat <br />Sample Location: 1. b C) <br />x Description: Chlorine resldu*. ? s [IF] MG/L Temp- Water ? ? F <br />g Address: Comments: <br />G <br />CRY C.? <br /> TEST ORDER (Che ck appropriate box) : <br />CHEMISTRY- INORGANIC CHEMISTRY- ORGANIC RADIOCHEMISTRY <br />? Alkalinity, Phenolphthalein ? Molybdenum ? Carbamates ? Alpha/Beta, Gross <br />- -O-Alkarmky; Total - -0 -Nickel - -- -- - ---?-VOC-- - -- -Q Americium <br />? Akuninum ? Nitrogen, Ammonia Dist. ? THM ? Carbon-14 <br />? Antimony 0 Nidro n, lCektahl ? BTEX ? Gamma Screen <br />O Arsenic ? Nitrogen, Total* O DIQUAT ? Gamma <br />Spectrometry, <br />? Barium ? Nitrate/Nitrite ? SOC s <br />? Beryllium ? Nitrite O SVOC ? Leak Test <br />? BOD ? pH ? Pesticides ? Plutonium <br />? Boron O Phosphate, Ortho ? Glyphosate ? Radium 226 <br />? Cadmium ? Phosphate, Total p Herbicides i ? Radium 228 <br />? Calcium ? Potassium ? EDB/DBCP ? .Radon <br />? Chloride s <br />1 O Selenium ^n Aft ? Thorium <br />T <br />i <br />i <br />C Chlorine, total residual <br />? Silicon (silicates) ? <br />r <br />um <br />t <br />? Chromium ? O ? Other. <br />? Conductivity ? Silver ? HEM (Oil Grease) ? Other. <br />? Copper ? Sodium ? Other <br />? CqMwAftbjMrd t .) ? Solids, Dissolved ? Other <br />MICROBIOLOGY <br /><;;Canide, Dist. W CD Solids, Suspended <br />uoride ? Solids, Total ? Total Cordbims, PA <br />? Hardness, total ? Sulfate Phase 1,2,5 -ANALYSES ? Total Cordorms, MTF <br />? Iron ? Thallium ? Heterotrophic Plate Count <br />1:1 Lead ? Uranium ? Organic (SOC / VOC) ? Pseudomonas MPN <br />? Magnesium ? Zinc ? Inorganic 0 E. Coll., MPN <br />? Manganese ? Other. ? Other <br />[; Mercury ? Other. n Other. <br /> <br /> <br />-n <br />OW -7,M-0$ z <br />LARS Intemet Address: http:/lwww.cdphe.state.co.us/ir/lrhom.htm <br />Report X25OReq, Rev 12IMM