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f Laboratory and Radiation Services Divdsio° 1! <br />8100 Lowry Boulevard, Denver CO 8023r System ID 1 -2009003443 <br />US Mail: PO'Box 17123, Denver CO 802 Collection Date 4/6/2009 9:30:OOAM <br />C-1 & rK K (303) 692-3090 fax (303) 3449989 <br />or He" Control Number 34 <br />WA FavkonoW <br />REQUEST FOR ANALYTICAL SERV <br />"'? • - <br />F CustomeNO c/o CAIN <br />-? Nam: t<K <br />Address : t??3 S 0? hT\? 3t- ewkj. <br />Contact: -4 / ° BUS <br />? Phone <br />PWS ID: ?? , <br />u U <br />il U <br />Sample Location: <br />Description: _ <br />:? US <br />x <br />\j 1 c:r <br />(i address: <br />C- it T <br />CCity- <br />tDV- St Zip: <br />am. <br />COlected: [-OR /t-?-"J/LLL E Time: I 'n I : 44P.M. <br />monUr day yeaf boor Collected by: Matri c <br />? Surface Water <br />? Ground Water <br />? Treated Water <br />Purpose: bRoutine ? Special Purpose ? Repeat. <br />Chlorine residua. Fla F1 11 MGIL Temp., Water: [][]F <br />Comments: <br />TEST ORDER (Che ck appropriate box) : f: U sa ON W) <br />CHEMISTRY- INORGANIC CHEMISTRY- ORGANIC RADIOCHEMISTRY <br />? Alkalinity, Phenolphthalein ? Molybdenum ? Carbamates ? Alpha/Beta, Gross <br />O Alkalinity, Total ? Nickel ? VOC ? Americium <br />? Aluminum _---_,__-- -0-Nitrogen,-Ammonia Dist. -- ---- -O THM- - - - - -- <br />_ .__ ? ..Carbon=14--- -- ` - _ <br />O Antimony ? Nitrogen, tgeidahl ? BTEX ? Gamma Screen <br />O Arsenic O Nitrogen. Total ? DIQUAT . Gamma Spectrometry, <br />? Barium O Nitrate/Nitrite ? SOC ? Nuciide Specific <br />? Beryllium ? Nitrite ? SVOC ? Leak Test <br />? am ? pH ? Pesticides ? Plutonium <br />? Boron ? Phosphate, Ortho ? Giyphosate .?. Radium 226 <br />? Cadmium ? Phosphate, Total ? Herbl6des ? Radium 228 <br />O Calcium ? Potassium ? EDBIDBCP ? . Radon <br />? Chloride O Selenium ? PCB O Thorium <br />C Chlorine, total residual ? Silicon (silicates) ? TOC ? Tritium <br />? Chromium ? DRO ? Other. <br />? Conductivity O Sir ? HEM (Ol Grease) ? Other. <br />O Copper ? Sodium <br />. <br />? Other <br />? Corroslv tftMd t .) ? solids, Dissolved O Other. MICROBIOLOGY <br />Cyanide, Dist 0 Solids, suspended <br />I <br />? e <br />? Fluoride Solids, Total Z ? <br />o)ftq od idw &L , PA. <br />O Hardness, total ? Sulfate phase 1,2,5- ANALYSES O Total Cordorms, MTF <br />? Iron O Thallium ? Heterotrophic Plate Count <br />I:1 Lead O Uranium ? Orgarflc (SOC / VOC) ? Pseudomonas MPN <br />? Magnesium ? Zinc ? Inorganic ? E. Col., MPN ! :r <br />? Manganese ? Other O Other. <br />? Mercury ? Other <br />i <br />I .0 Other. <br />LARS Internet Address: http://www.cdphe.state.co.usAr/lrhom.htm ' <br />ROPW VMRn Rw 1201/99