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F Laboratory and F <br />8100 Lowry Boui <br />US Mail: PO'Bo) <br />Cokra& DqmCbMeM (303) 692-3090 <br />orruwICrte <br />md Exvkamcd <br />REQUEST FOR ANA <br />System ID ENV-2009000600 <br />Collection Date 111512o09 9.00.0oAM <br />Control Number 75 <br /> CUSTOMER IN FORMA TION <br /> CONected• 1 / .l O Tune: am. <br /> Name : <br />Address: monih day year four min ? Am- <br /> \ ? <br />' <br />3 T` ??T la Collected by: Mat bc <br /> ? <br />- <br />?'?'`V _ ? Surface Water <br /> <br />ri Contact <br />? <br />? Ground Water <br /> Phone : ? Treated Water <br /> <br /> <br />i <br />PWS ID: 11 <br /> Purpose: ? Routine ? Special Pu rpose E] Repeat <br /> Sample <br />Location: ?_.6 l? NJ C? <br />At I . <br /> Description: Chlorine residual: a D D MG/L TemP, Water- ? ? F <br /> . <br />x <br />g Address: Comments: <br /> city' St Zip: <br />? <br />TEST ORDER (Che ck appropriate box) : o <br />CHEMISTRY- INORGANIC CHEMISTRY- ORGANIC RADIOCHEMISTRY <br />? AlkaGnily. Phenolphthalein ? Molybdenum ? Carbamates O Alpha/Beta, Gross <br />O Alkarmty, Total ? Nickel ? VOC 0 Americium <br />- - O-Aluminum --- -- -O -Nitrogen,-Ammonia-Dist. ---o-THM --0-CaftrP14 <br />--- <br />O Antimony ? Nitrogen, K)eidahl ? STEX ? Gamma Screen <br />O Arsenic O Nitrogen, Total' ? DIQUAT Gamma Spectrometry, <br />p Barium O Nitrate/Nitrite O x0C <br />(? p Nudide Specific <br />? Beryllium 0 N'drhe O ? <br />? Leak Test <br />? BOD O PH : <br />O P p Plutonium <br />p Boron ? Phosphate, Ortho O GW to .O. Radium 226 <br />.0 Cadmium p Phosphate, Total p Herbicides ? Radium 228 <br />? Calcium p Potassium ? EDBIDBCP ? . Radon <br />O Chloride ? Selenium ? PCB p Thorium <br />? Chlorine, total residual p Silicon (silicates) ? TOC ? Tritium <br />? Chromium ? DRO ? Other. <br />? Silver <br />? Conductivity ? HEM (Oil Grease) 0 Other. <br />? Copper ? sodium ? odor <br />? . ? solids, Dissolved ? other <br />MICROBIOLOGY <br /> <br />O Solids, Suspended <br />? amide, Dist <br />? Solids, Total ? Fluo ' e p Total Conforms, PA <br />O Hardness, total ? Sulfate phase 1,2,5 - ANALYSES O Total Cordom s, MTF <br />? Iron ? Thafiium ? Heterotrophic Plate Count <br />0 Lead ? Uranium O Organic (SOC I VOC) ? Pseudomonas MPH <br />O Magnesium O Zinc 0 Inorganic O E. Con., MPH <br />p Manganese ? Other O Other <br />C: Memay ? Other. ? Other. <br />i I <br /> => <br />t?Tl <br />LARS Internet Address: http:/Mww.cdphe.state.co.usAr/lrhom.htm n <br />C?7 <br />1> -