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f Laboratory and Radlatlo?--- ' <br /> 8100 Lowry Boulevard,, <br />.i, . US Mail: PO Box 17123 <br />Svstem ID <br /> e o (303) 692-3090 fax (3( <br />orwic di Collection Date ENV-2009000596 <br />111512009 <br /> <br />Control Number 10:00:00AM <br />71 <br /> REQUEST FOR ANALYTIC. __ _ _ JD?? <br />'? • - SAM PLE <br />= INFORMATION <br /> Customew <br />?. , <br />Collected: / . <br />! Time: am. <br /> <br /> <br />J J <br />Nam: Address: <br />'J t J <br />P m <br />motet day year hour min <br /> // -??? Collected by: Maauc ?- -? <br /> Con ? Surface Water <br /> ? Treated Water <br /> SAMPLE SITE CO MMENTS <br /> <br />PINS ID: <br />u <br /> <br />P <br /> urpose : ? Routine ? Special Purpose ? Repeat <br /> Sample Location: LLAlAf <br />Description: <br />Chlorine residuah as <br />? D MG& Temp Water: 00 F <br /> <br /> Address: Comments: <br />? Cdy: St: Zip. <br />TEST ORDER (Che ck appropriate box) : O <br />CHEMISTRY- INORGANIC CHEMISTRY- ORGANIC RADIOCHEMISTRY <br />? Alkalndy, Phenolphthalein ? Molybdenum ? Carbamates ? Alpha/Beta, Gross <br />? Alkarmity, Total ? Mickel ? VOC ? Americium <br />-l] Akxninum- --El -NitrogeN4km nonla-DisL-- p THM - - ---- -p-Carbon-14 - - - <br />? Antimony ? Nitrogen. IQeldahl ? BTEX O Gamma Screen <br />? Arsenic ? Nitrogen, Total- ? DIQUAT <br />ctrometry, <br />Spectrometry, <br />; Gamma <br />? Barium O Nitrate/Nitrite ? SOC e <br />? Beryllium ? Nitrite ? SVOC ? Leak Test <br />O BOD ? pH <br />? Boron ? Phosphate, Ortho ? Pesticides <br />? Glyp to ? Plutonium <br />.?, Radium 226 <br />.0 Cadmium ? Phosphate, Total ? Herbicid ? ? Radium 228 <br />? Calcium ? Potassium O EDSO ? .Radon <br />? Chloride ? Selenium ? PCB O Thorium <br />? Chlorine, total residual <br />? Simon (silicates) ? TOC ? Tritium <br />? Chromium ? ORO [] Other. <br />? Conductivity ? Steer ? HEM (04 Grease) ? Other. <br />? Copper ? Sodom O <br />Other <br />? ? solids, Dissolved ? Other. MICROBIOLOGY <br />st f5 Solids, Suspended <br />)?? <br />_ <br />Li Solids. Tot al ? Total Coliforms, PA <br />? Hardness, total O Sulfate Phase 1,2,5 -ANALYSES ? Total Cordorms, MTF <br />O Iron ? Thallium ? Heterotrophic Plate Count <br />1] Lead O Uranium ? Organic (SOC / VOC) ? Pseudomonas MPN <br />? Magnesium ? Zinc ? Inorganic ? E. Coll., MPN <br />? Manganese ? Other ? Other <br />? Mercury ? Other C) Other. <br /> <br /> I <br />f ? <br />t:Tl <br />C? <br />CD <br />LARS Intemet Address: http://www.cdphe.state.co.usllrArhom.htm <br />Rport XMRn Rw 12WM <br />W <br />C+?