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Laboratory and Radiation Services Division <br />8100 Lowry Boulevard, Denver CO 80230-A <br />US Mail: PO Box 17123, Denver CO 80217 <br />cor«aeo> (303) 692-3090 fax (303) 344-9989 <br />orhOria He" <br />d Eivronw"A <br />REQUEST FOR ANALYTICAL SERVII <br />Collection Date 9/14/2009 9.-20.-OOAM <br />Control Number 48 <br />.? <br />CUSTOMER <br />SAM <br />PLE INFORMATION <br /> Customew CoNeded f07 79M Time: am. <br /> Name • <br />Addr <br />ss : mono day year hour min ? AM- <br /> e <br />k5 <br />? <br />Collected by: <br />maw <br /> <br /> ?C? &63 S <br />f <br /> <br />contact ? <br />ur <br />ace water <br /> ? Ground Water <br /> Phone : ? Treated Water <br /> SAMPLE SIT E CO MMENTS <br /> <br />PYVS ID: <br />- - <br />? I <br />--Tg <br /> <br />i <br />L? Purpose : 0 Routine ? Special Purpose ? Repeat <br /> on: <br />Sample locat <br /> tion: <br />Desa Chlorine residual: ? a MG& Temp- Water: ?? F <br /> P a <br />x <br />g Address: Comments: AY <br /> Cdy: St ZIP' <br />? <br />TEST ORDER (Che ck appropriate box) : 0 <br />CHEMISTRY- INORGANIC CHEMISTRY- ORGANIC RADIOCHEMISTRY <br />? ANkalinity, Phenolphthalein ? Molybdenum ? Carbamates ? Alpha/Beta. Gross <br />? Alkalinity, Total ? Nickel ? VOC ? Americium <br />_?_Aluminum, _0 Nitrogen. Arontonia=Dist~ p_: TkNW-- --- -- p Carbon-14- <br />0 Antimony ? Nitrogen, lgeldahl ? BTEX ? Gamma Screen <br />? Arsenic ? 'Nitrogen, Total' ? DIOUAT Gamma Spedrornetry, <br />? <br />? Barium ? Nitrate/Nitrite ? SOC Nudide Specific <br />? Beryllium ? NiWbe ? SVOC ? Leak Test <br />? BOD ? pH ? Pesticides ? Plutonium <br />? Boron ? Phosphate, Ortho ? Glyphosate ,?. Radium 226 <br />? Cadmium ? Phosphate, Total ? Herbicides ? Radium 228 <br />? Calcium ? Potassium ? EDSMCP ? .Radon <br />? Chloride ? Selenium ? PCB ? Thorium <br />? Chlorine, total residual ? Silicon (silicates) ? TOC ? Tritium <br />? Chromium ? DRO ? Other. <br />? Silver <br />? Conductivity ? HEM (Oil Grease) ? Other. <br />? Copper ? sodium ? Other <br />? Solids, Dissolved ? Ott MICROBIOLOGY <br />- Soros suspended <br />? Cyanide, Dist. <br />e ? Solids, Total ? Total Coliforms, PA <br />? Hardness, total ? Sulfate Phase 1,2,5 - ANALYSES ? Total Conforms, MTF <br />? Iron ? ThaNum ? Heterotrophic Plate Count <br />0 Lead ? Uranium ? Organic (SOC / VOC) ? Pseudomonas MPN <br />? Magnesium ? Zinc ? Inorganic ? E. Col., MPN <br />? Manganese ? Other e ? Other <br />p Mercury ? Other <br />r lb Other. <br />t;?7 <br />ff <br /> <br />V <br />LARS Intern et Address: http://www.cdphe.state.co.usnr/lrhom.htm ? <br />r Awd 02SORn Rw 12MIN CJ <br />tat