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r: <br />Laboratory and Radiation Services DivV - <br />8100 Lowry Boulevard, Denver CO 8M <br />US Mail: PO 'Box 17123, Denver CO 8( <br />cot«a& (303) 692-3090 fax (303) 344-9989 <br />orWK He" <br />wI Faviar <br />REQUEST FOR ANALYTICAL SER _ <br />System ID ENV_2009010240 <br />Collection Date 9/14/2009 9:20:OOAM <br />Control Number 46 <br />SAMPLE1 • • <br />CUSTOMER <br />CustaneriD f Cog cted: O / M/ Time: ?l gm <br />+ Name : t? 1c ,no„tl, day year how m? ? . <br />Address: rrr. <br />hj ?3 SY?6?M <br />Cdlected by. Matrix <br />contact 4D V CrK.. J ??? p Surface Wager <br />? Ground Wager <br />Phone`( ???? +?? p Treaded Wager <br />SAMPLE. -SITE---- COMMENTS - <br />PWS W: 0-T' Purpose : ? Routine . ? Special Purpose ? Repeat <br />Sample Location: <br />Lb W <br />Chlorine residual: a a F IF] MG/L TemP., Water [][]F <br />Address: Commerce: <br />? CdT St: zip. <br />TEST ORDER (Che ck appropriate box) : <br />LAP, U14 <br />CHEMISTRY- INORGANIC CHEMISTRY- ORGANIC RADIOCHEMISTRY <br />? Alkalinity, Phenolphthalein ? Molybdenum ? Carbamates ? Alpha/Beta, Gross <br />? Alkalinity, Total ? Nickel ? VOC ? Americium <br />? _ Akxnfnum _ _ . _ . _ __ - _ _ _? _ Nrtrogen,,Arnnwnia Drsi _. _ _ _ _ O THM-? _ ?.. - _ _ ??-Carbor?-14 - -- -- - - - <br />? Antimony ? Nitrogen, IQeldahl ? STEX ? Gamma Screen <br />? Arsenic ? Nitrogen, Total' ? DIQUAT Gamma Spectrometry, <br />? <br />? Barium ? Nitrate/Nitrite O SOC Nukdide Specific <br />? Beryllium ? Nitrite ? SVOC ? Leak Test <br />O BOO ? pH ? Pesticides ? Plutonium <br />? Boron ? Phosphate, Ortho ? Glyphosa to O, Radium 226 <br />? Cadmium ? Phosphate, Total ? Herbiades ? Radium 228 <br />? Calcium ? Potassium ? EDB/DBCP ? .Radon <br />? Chloride p Selenium ? PCB ? Thorium <br />? Chlorine, total residual ? Spicon (silicates) O TOC ? Tritium <br />? Chromium ? DRO ? Other. <br />? SlIver <br />? Conductivity ? HEM (01 Grease) ? Other. <br />? Copper ? Sodium ? Other <br />tem .) ? Solids, Dissolved J O"Ier MICROBIOLOGY <br /> <br />b Solids, Suspended <br />O Cyanide, Dist ?Wkob? <br />? Fluoride ? Solids, Total ? Total Cotiforms, PA <br />? Hardness, total ? Sulfate Phase 1,2,5 -ANALYSES ? Total Coliforms, MTF <br />? Iron O Thallium ? Heterotrophic Plate Count <br />01 Lead ? Uranium ? Organic (SOC / VOC) ? Pseudomonas MPN <br />? Magnesium ? Zinc ? Inorganic ? E. Col., MPN <br />? Manganese ? Other ? Other <br />[) Mercury ? Other: So 9 0 Other. <br />i I <br />COO <br />LARS Internet Address: http://www.cdphe.state.co.usllrArhom_htm T <br />ti <br />PANd s29DPAn Rw IMIN <br />W