|
Laboratory Services Division
<br />r 8100 Lowry Boulevard, Denver, CO 80230-6928
<br />1`') US Mail: PO Box 17123, Denver, CO 80217
<br />(303) 692-3090 fax (303) 344-9989
<br />Colorado l kspanment
<br />of Publi. Nemith
<br />and Em"ment
<br />REQUEST FOR ANALYTICAL SERVICES Collection No: ?
<br />• •- •
<br />;ustomerlD : 00009830
<br />Collected:
<br />a? Time??
<br />00-00 0 ? a.m
<br />o
<br />lame : Department of Natural Res ources , ? p.m
<br />%ddress : 1313 Sherman Street Room 215 month day year hour min
<br /> Collected by : Water Type:
<br />;ity/SUZip : Denver CO 80203
<br />Shone : 303-866-3567 Purpose: E] Routine Special Purpose Repeat
<br />=mail:
<br />;ontact : Berhan Keffelow ? Compliance Personal Information
<br />=ax:
<br />SAMPLE SITE Chlorine residual: 0.00 mg/L Water Temperatu re Do- C
<br />IWS ID : Coo a ? ? ? - ? ? Fluoride [] . OF]o mg/L
<br />ystem Name:
<br />Temperatu
<br />re at Receipt:
<br />address: Comments:
<br />city Coun ty State zip
<br />
<br />)escri
<br />tion:
<br />p
<br />Location Source
<br />?Real Estate/HUD (Coliform Bacteria, COMPLIANCE DRINKING WATER TESTS Inorganic Parameters Organic Parameters
<br />Lead, Nitrate and Nitrite) Oraanic Chemicals Rule ?Alkalinity ?Oil and Grease
<br />?Annual Colorado Package ?EDB/DBCP ? BOD ?CBOD ?DO ?VOCs Screen
<br />(Coliform Bacteria, Nitrate/Nitrite) ?Chlorinated Pesticides ?Chemical Oxygen Demand (COD) ?SVOCS/Pesticide
<br />?Expanded Annual Colorado ?PCBs (Subcontracted) ?Chloride Screen
<br />Package (Coliform Bacteria, ?Chlorinated Herbicides ?Chlorine a ?BTEX
<br />Nitrate/Nitrite, pH, TDS) ?Volatile Organic Compounds (VOCs) ?Chromium, hexavalent (Cr ) Radiochemistry
<br />?General Colorado Package ?Semivolatile Organic Compounds (SVOCs) ?Corrosivity (Langlier) ?GrossAlpha/Beta
<br />(Arsenic, Coliform Bacteria, Hardness, ?Carbamate Pesticides Cyanide ? Direct ? Distilled ?Radium 226
<br />Copper, Fluoride, Iron, Lead, ?Diquat (Subcontracted) ? WAD ?Radium 228
<br />Nitrate/ Nitrite, Uranium) ?Endothall ?Fluoride ?Uranium
<br />?Deluxe Colorado Package ?Glyphosate ?Hardness ?C-14
<br />(Alkalinity, Arsenic, Cadmium, Calcium, Inorganic Chemicals Rule ?Mercury ?Radon
<br />Coliform Bacteria, Chloride, ?Primary Metals (Sb, As, Ba, Be, Cd, Cr, Hg, Individual Metals ?Aluminum ?Ni-63
<br />Conductivity, Copper, Corrosivity, Ni, Se, Na TI) + Fluoride ?Antimony ?Arsenic ?Barium ?Gamma Spectrometr
<br />Fluoride, Hardness, Iron, Lead, ?Primary Metals (Sb, As, Ba, Be, Cd, Cr, Hg, ?Beryllium ?Cadmium ?Calcium Specific Isotopes (list):
<br />Magnesium, Manganese, Ni, Se, Na TI) + Fluoride + Cyanide ?Chromium ?Cobalt ?Copper -
<br />Nitrate/ Nitrite, pH, Sodium, Sodium Nitrogen, ?Nitrate ? Nitrite ?Iron ?Lead ?Magnesium
<br />Adsorption Ratio, Sulfate, Total Lead and Copper Rule ?Manganese ?Molybdenum Food Testing
<br />Dissolved Solids, Uranium, Zinc) ?Lead and Copper ?Nickel ?Potassium ?Selenium ?Equilibrium pH
<br />?Mining Baseline Package (pH, Radionuclides Rule ?Silver ?Sodium ?Strontium ?Starch
<br />Nitrate/ Nitrite, Aluminum, Arsenic, ?Gross Alpha/Beta ?Sulfur ?Thallium ?Tin ?Fat
<br />Cadmiun, Copper, Iron, Lead, ?Radium 226 ?Tungsten ?Uranium ?Zinc ?WaterActivity
<br />Magnesium, Manganese, Potassium, ?Radium 228 Nitrogen, ?Ammonia Preservatives (list):
<br />Selenium, Sodium, Sulfur, Uranium, ?Uranium ? Nitrate/Nitrite ? Total Kjeldahl
<br />GrossAlpha/Beta)
<br />Sulfate Disinfection Byproducts ?Nitrate ? Nitrite
<br />,
<br />?Mining Baseline Package without ?TotalTrihalomethanes (TTHMs) ?pH ?Mercury
<br />Gross Alpha/Beta ?Haloacetic Acids (HAA5s) ?Phenol Metals (list):
<br />il ?Alkalinity Phosphorus
<br />?Drilling Baseline Package (Volat
<br />e
<br />?Bromate ?Bromide ?Bromite
<br />Ortho
<br />?Phosphate - -
<br />Organic Compound Screen, pH, Total , i
<br />F
<br />d
<br />i
<br />Fluoride,
<br />Dissolved Solids
<br />Chloride ?Chlorate ?Chlorite ?Phosphate, Total n
<br />oo
<br />?Bacter
<br />a
<br />,
<br />,
<br />Alkalinity, Sulfate, Nitrate/Nitrite, Organic Carbon ?Total ? Dissolve d ?Sodium Adsorption Ratio Suspect:_
<br />Barium
<br />Calcium
<br />Chromium
<br />Arsenic ?UV @ 254 Solids ?Dissolved ?Settleable Suspect:- -
<br />,
<br />,
<br />,
<br />,
<br />Magnesium
<br />Selenium
<br />Sodium
<br />Iron Total Coliform Rule Microbiol /Bacteria ?Suspended ?Total ?Volatile Miscellaneous
<br />,
<br />,
<br />,
<br />,
<br />Sulfur, and Uranium) ?Total Coliform (Present/Absent, w/ E. coli) ?Specific Conductance ?Soils/Filters -XRF
<br />?Drilling Baseline Package without ?E. coli (Enumerated, w/ Total Coliform) ?Sulfate metals (list):
<br />VOC screen. ?Total Coliform (Multiple Tube enumeration) ?Sulfide -
<br />?Metals Scan: (Aluminum, Arsenic, ?Coliform, Fecal (Multiple Tube enumeration) ?Turbidity
<br />?Unknown Substance
<br />Barium, Beryllium, Cadmium, Calcium, ?Heterotrophic Plate Count ?Other Inorganic: ti
<br />FTIR
<br />Id
<br />tifi
<br />I
<br />d
<br />Ch
<br />i
<br />C
<br />L ?Other Microbiology: on (
<br />)
<br />en
<br />ca
<br />opper,
<br />ron,
<br />,
<br />rom
<br />um,
<br />ea --
<br />l
<br />bdenum
<br />M
<br />i
<br />M
<br />M -
<br />y
<br />,
<br />agnes
<br />um,
<br />anganese,
<br />o
<br />i
<br />l
<br />ni
<br />m
<br />Silver
<br />Ni
<br />k
<br />l
<br />P
<br />t
<br />S - -
<br />-
<br />,
<br />,
<br />e
<br />,
<br />o
<br />ass
<br />um,
<br />e
<br />e
<br />u
<br />c --
<br />Sodium, Uranium, Zinc
<br />CHAIN OF CUSTODY:
<br />RELINQUISHED BY: DATE/TIME: RECEIVED BY: DATE/TIME:
<br />RELINQUISHED BY: DATE/TIME: RECEIVED BY: DATE/TIME:
<br />RELINQUISHED BY: DATE/TIME: RECEIVED BY: DATE/TIME:
<br />LSD Interent Address: http://www.cdphe.state.co.us/Ir/lrhom.htm Report #250Req
|