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<br /> <br />-M <br />Laboratory and Radiation Services Division <br />8100 Lowry Boulevard, Denver CO 80230 System ID ENV-2009010243 <br />US Mail: PO Box 17123, Denver CO 8021 Collection Date 9/14/2009 9:40:OOAM <br />Calm& OfINWIK rt (303) 692-3090 fax (303) 344-9989 Control Number 49 <br />*W EnrironumW <br />REQUEST FOR ANALYTICAL SEh[ <br />Customerm <br />Name !6&, -(OA <br />Address: k N I S%-Ituu? S` Q4WTzwn -, c <br />C!WWz1p= <br />contact <br />?M3 -3 (-11 <br />Collected. 01! I/lJL_J/LJL11 Tune: I If ( I: La ??'1 I <br />mono okay year hour min ' ?- P.M. <br />careered by. Matra <br />? E::::::?= <br />Surface Water <br />? Ground Wlarer <br />? Treated Water <br />PWS la: U ? ?i ? ? El - <br />Purpose: ? Routine ? Special Purpose ? Repeat <br />Sample Location: <br />Description: Chlorine residual: ?. ? ? MGIL Temp.. Water: F <br />x - ?? <br />Address: Comments: /V City: St zip. <br />TEST ORDER (Check appropriate box) : pi <br />CHEMISTRY- INORGANIC I CHEMISTRY- ORGANIC RADIOCHEMISTRY <br />E?9 <br />? Alkalinity, Phenolphthalein ? Molybdenum ? Carbamates <br />? Aeta <br />Gross <br />O Alkarmityr, Total O Nickel ? VOC , <br />? Americium <br />? Aluminum ? Nitrogen, Ammonia Dist ? THM ? Carbon-14 <br />O Antimony O Nitrogen, K)eldahl ? STEX <br />? Gamma Screen <br />O Arsenic ? N. <br />Nitrogen, Total' O DIQUAT , Gamma Spectrometry <br /> <br />O Barium <br />? Nitrate/Nitrite <br />O SOC , <br />O Nuclide Specific <br />? Beryllium ? Nitriba ? SVOC <br />? Leak Test <br />? BOD ? pH ? Pesticides ? Plutonium <br />? Boron O Phosphate, Orh O Glyphosate <br />Radium 226 <br />O <br />? Cadmium ? Phosphate, Total O Herbicides , <br />? Radium 228 <br />? Callum ? Potassium O EDBIDBCP <br />? .Radon <br />? Chloride O Selenium O PCB O Thorium <br />? Chlorine, total residual <br />? Silicon (silicates) <br />D TOC <br />? Tritium <br />? Chromium O Silver ? DRO ? Other. <br />? Conductivity <br />? sodium ? HEM (Oil Grease) ? Other. <br />? Copper ? <br />? <br />vl[y rerecd Solids, Dissolved <br />? ? <br />Other <br /> <br />?yanide, <br />Dist Ul <br /> <br />b Solids, Suspended _ <br /> <br />MICROBIOLOGY <br />uoride ? Solids, Total <br /> <br />? Hardness, total <br />D Sulfate ? Total Cofiforrns, PA <br /> <br />? Iron <br />? Thalium phase 1,2,5 - ANALYSES ? Total CorAorms, MTF <br />i? Lead ? Uranium D Heterotrophic Plate Count <br /> ? Organic (SOC / VOC) ? Pseudomonas MPN <br />O Magnesium ? Zinc ? Inorganic E. Col., MPN <br />? Manganese ? Other. <br />Other. <br />[; Mercury ? Other <br /> I to <br /> I m <br /> ' <br />t7 <br /> <br /> C? <br /> <br />LARS Internet Address: http://www.cdphe <br />state <br />co <br />us/ir/lrhom <br />htm to <br /> . <br />. <br />. <br />. <br />ROPW tea, rsw 12MI" -` <br /> W <br /> a <br /> co <br />