Laserfiche WebLink
F <br />w' Laboratory and Radiation Services Division System ID ORG-2008000208 <br />8100 Lowry Boulevard, Denver, CO 80230-6928 <br /> <br /> <br />J» <br />US Mail: PO Box 17123, Denver, CO 80217 <br />(303) 692-3090 fax (303) 344-9989 Collection Date 8 <br /> <br />(1 Control Number 4 <br />I /21/2008 3:45:OOPM <br />rad t J <br />of Pub cHcahh <br />and Envimrimait <br />REQUEST FOR ANALYTICAL SERVICE S Collection No: u U U U U U U LJ <br />CUSTOM ER SPECIMEN INFOR MATION <br />CustomerID: <br />Name ame i WP013098 <br />Molen and Associates LLC _?? _ <br />Collected: ? <br />d ®? o n? El a.m <br />Time ?L p <br />P( <br />m <br />Address : 2090 East 104th #202 <br />h day year . <br />hour min <br />Cit Thornton Co 80233 y/St/Zip <br />Received: Time <br />Phone : 303-450-1600 month day year hour min <br />Contact : Mark Molen <br />Contact Phone <br />Collected by: <br />Water Type: <br />SAMPLE SI TE COMM ENTS <br />PWS ID: COO ELI ? [1? - ? ? T Purpose: Routine E] Special Purpose Repeat <br /> <br />Name: 5 <br /> <br />mg/L <br />Chlorine residual: 0'00 <br /> <br />Temp., Water C <br />Address: 1 <br /> 4qy? A&µ` cz <br />- Temperature at Receipt: <br /> oun tom <br />p <br />1 <br />Comments: <br />Description: <br /> Location Source - Point of location <br /> TEST ORDER (Check appropriate box): <br /> CHEMISTRY-INORGANIC CHEMISTRY-ORGANIC RADIOCHEMISTRY <br />? Alkalinity, Pheno lpathalein ? ICP Scan ? Solids, Total ? Phase 1 2 5 ? Alpha/Beta, Gross <br />? Alkalinity, Total ? Lead ? Sulfate ? VOC (Regulated) ? Americium <br />? Aluminum ? Lithium ? Thallium ? SOC (Regulated) ? Gamma Spectrometry, <br />? Antimony ? Magnesium ? Uranium ? DBP (Regulated) Nuclide Specific <br />? Arsenic ? Manganese ? Zinc ? VOC (Screen) ? Plutonium <br />? Barium ? Mandatory ? Other: ? SVOC (Screen) ? Radium 226 <br />? Beryllium ? M(Phase ercury I, II, V) <br />ry ? HEM (Oil & Grease) 13 Radium 228 <br />C3 BOD <br />? Molybdenum ? THM 13 Radon <br />? BOD, Carbonace ous <br />? Nickel ? BTEX ? Thorium <br />? Boron <br />13 Cadmium E3 Automated Ammonia ?. TOC <br />Other:( ??? <br />E3 Uranium <br />? Nitrogen, Kjeldahl <br />? Calcium (Carbonate) <br />? Other: ? Leak Test <br /> <br />? Chloride ? Nitrogen, Total <br />? Other: ? Alpha/Beta, Gross <br /> <br />? Chlorine <br />Total re ? Nitrogen, Nitrate/Nitrite <br />sidual <br />? Other: ? Carbon-14 <br />, <br />? Nitrogen, Nitrite <br />? Chromium <br />? Other: ? Ni-63 <br /> <br />? Conductivity ? Nitrogen, Nitrate <br />? Other: ? H-3 <br />? Copper ? H <br />p ? Other: <br /> <br />13 Corrosivity (Langli ? Phosphate, Ortho <br />er) MICROBIOLO <br />? Cyanide, Distilled 13 phosphate, Total ? Total <br />Colims, PA 13 Other: <br />? Cyanide, Direct 13 Potassium ? To <br />T Iff orms, MTF <br />u <br />O <br />n <br />CPD <br /> <br />? Cyanid e, WAD 11 Selenium V <br />C <br />O <br />I <br />E:3 F orms, MTF <br /> <br />El Fluoride ? Silicon (silicates) ? E.N ? VOC <br /> <br />11 Hardness total Silver <br />13 P <br />? Hehic Plate Co <br />unt 13 Fat + Preservatives In Meat <br /> <br />? Heavy Metals ? Sodium ? <br />Pseudomonas Culture ? Water Activit <br />Y <br />n <br />Iron 11 Solids, Dissolved 13 Other: 11 Other: <br /> ? Solids, Suspended ? Other: <br />? <br />ISPOSITION _ CHAIN OF CUSTODY <br />- - - - D ?E / T ]ZFfCE1E1?B? 4 ! DATE / TIME <br /> <br />:ELINQUISHED BY: DATE / IME RECEIVED BY: TIME <br />D <br /> ?tj <br />tELINQUISHED BY:. DATE / TIME RECEIVED BY: DATE / TIME <br />ARS Interent Address: http://,Aww.cdphe.state.co.us/Ir/h-hom.btrn Report #250Req, Date of Modification:7/31/2008