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Laboratory and Radiation Services Division <br />8100 Lowry Boulevard, <br />US Mail: PO Box 17123, <br />692 3090 fax 30' <br />Orr IC He" (?3) ( Svstem ID ENV-2009000597 <br />Collection Date 1/15/2009 9: ,0:00AM <br />REQUEST FOR ANALYTIC <br />Control Number 72 <br />Custornew <br />Name: <br />? Adder <br />: <br />131!-?- ?-?j <br />Contact: <br />Phone a C <br />ITZ a u - <br />PWS 10: <br />Sample Location: <br />g Description: <br />City: <br />colleded: I ? ? ?/? ?l_?W?Iq I Tine: lJ I ' 9 : L ? I <br />monlhJ ?Jy -year , /? Amin <br />Collected by: Matrix <br />? Surface water <br />? Ground Water <br />? Treated Water <br />Purpose : ? Routine ? Special Purpose ? Repeat <br />Chlorine residual. 0. ? F] MG/L Temp- Water. a F <br />Comments: <br />St: Zip: II <br />TEST ORDER (Che ck appropriate box) <br />CHEMISTRY - INORGANIC CHEMISTRY - ORGANIC RADIOCHEMISTRY <br />? Alkalinity, Phenolphthalein ? Moybdenum ? Carbamates ? Alpha/Sets, Gross <br />? Alkarmity, Total O Nickel ? VOC ? Americium <br />? Aluminum - - ?,-Nkrogen,-Ammonia Dist - ? THM - - - ?-Carbon44- -- --- - - <br />? Antimony ? Nitrogen, IQeldahl ? STEX ? Gamma Screen <br />? Arsenic ? Nitrogen, Total' ? DIQUAT q Gamma <br />Spectrometry. <br />? Barium ? Nitrate/Nitrite ? SOC e <br />? Beryffium ? Nitrite ? SVOC ? Leak Test <br />? SOD ? pH ? Pesticides ? Plutonium <br />? Boron ? Phosphate, Ortho ? Gyphosate ?. Radium 226 <br />? Cadmium ? Phosphate, Total ? Herbicides ? Radium 228 <br />? Calcium ? Potassium <br />? Chloride ? Selenium ? E CP <br />? PCB ? .Radon <br />? Thorium <br />? Chkxine, total residual ? Silicon (silicates) ? TOC ? Tritium <br />? Chromium ? DRO ? Other. <br />? Silver <br />? Conductivity ? HEM (Oil rease) ? Other. <br />? sodium <br />? Copper <br />? otf?r <br />. ? Solids, Dissolved ? ?? MICROBIOLOGY <br />ZCyan ide, t7 Solids, suspended <br />oride? Solids, Total ? Total Cordbrms, PA <br />? Hardness, total ? Sulfate Phase 1,2,5 -ANALYSES ? Total Conforms, MTF <br />? Iron ? Thallium ? Heterotrophic Plate Count <br />0 Lead El Uranium ? Organic (SOC / VOC) ? Pseudomonas MPN <br />? Magnesium ? Zinc ? Inorganic ? E. Con., MPN <br />? Manganese ? Other. ? Other <br />? Mercury ? Other. f_7 Other. <br />i I C <br />ti <br />CJ7 <br />ti <br />LARS Internet Address: http://www.cdphe.state.co.us/IrArhom.htm <br />RAPod *ZMPA q, Rw 12MM <br />Address: