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Laboratory Services Division
<br />8100 Lowry Boulevard, Denvf
<br />US Mail: PO Box 17123, Den'
<br />(303) 692-3090 fax (303) : System ID
<br />ENV-2009011199
<br />ta, c Y Collection Date 10/1/2009'.9:30.00AM
<br />vtartmrut
<br />Control Plumber 2
<br />REQUEST FOR ANALYTICA" - -
<br />
<br />CustomerlD : 00009830
<br />Collected:
<br />Time
<br />[6 0 S]o ? a.m
<br />Vame : Department of Natural Resources _ o ? p.m
<br />Address : 1313 Sherman Street Roo m 215 mon h day year hour min
<br /> Collected by : Water Type:
<br />City/St/Zip : Denver CO 80203
<br />Phone : 303-866-3567 Purpose: E] Routine E] Special Purpose Repeat
<br />Email:
<br />Contact : Berhan Keffelow E] Compliance E] Personal Information
<br />Fax:
<br />SAMPLE SITE Chlorine res idual: m9/L Water Temperature
<br />°C
<br />'WS ID: Coo ? ? ? ? ? . ? ? a Fluoride mg/L
<br />iystem Name:
<br />Temperatu
<br />re at Receipt:
<br />address: Comments:
<br />Coun ty State Lip
<br />)escription:
<br />Location Source
<br />[]Real Estate/HUD (Coliform Bacteria, COMPLIANCE DRINKING WATER TESTS Inorganic Parameters Organic Parameters
<br />Lead, Nitrate and Nitrite) Organic Chemicals Rule []Alkalinity ?Oii and Grease
<br />[]Annual Colorado Package 0EDB/DBCP ? BOD 0CBOD ?DO ?VOCs Screen
<br />(Coliform Bacteria, Nitrate/Nitrite) ?Chlorinated Pesticides []Chemical Oxygen Demand (COD) OSVOCS/Pesticide
<br />[]Expanded Annual Colorado []PCBs (Subcontracted) []Chloride Screen
<br />Package (Coliform Bacteria, ?Chlorinated Herbicides []Chlorine
<br />s ' ?BTEX
<br />_Nitrate1NitdtP--pH TIISa- -0Vola-tile-Org-anic-Compounds-(VOC-s)- -=hromium;-hezavalent-(Cr
<br />) Radiochemistry
<br />[]General Colorado Package ?Semivolatile Organic Compounds (SVOCs) vi (Langlier ?Gross Alpha/Beta
<br />(Arsenic, Coliform Bacteria, Hardness,. ?Carbamate Pesticides ect still d
<br />W ?Radium 226
<br />Copper, Fluoride, Iron, Lead, iqua ubcontracted)
<br />? ?Radium 228
<br />Nitrate/Nitrite, Uranium ndo all (
<br />1
<br />luoride ?Uranium
<br />[]Deluxe Colorado PF#k? ? lyph a 0Hardness ?C-14
<br />(Alkalinity, Arsenic, Ca miu alciur manic C micals Rule 0Mercury []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 Spectromet
<br />Fluoride, Hardness, Iron, Lead, ?Primary Metals (Sb, As, Be, 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 []Water Activity
<br />Magnesium, Manganese, Potassium, ?Radium 228 Nitrogen, []Ammonia Preservatives (list):
<br />Selenium, Sodium, Sulfur, Uranium, ?Uranium ? Nitrate/Nitrite ? Total Kjeldahl
<br />Sulfate, Gross Alpha/Beta) Disinfection Byproducts ?Nitrate 0 Nitrite _
<br />[]Mining Baseline Package without ?TotaITrihalomethanes (TTHMs) []pH ?Mercury
<br />Gross Alpha/Beta OHaloacetic Acids (HAA5s) ? Phenol Metals (list):
<br />[]Drillin
<br />Baseline Packa
<br />e (Volatile ?Alkalinity Phosphorus - -
<br />g
<br />g
<br />O
<br />i
<br />C
<br />d S
<br />H
<br />T
<br />t
<br />l ?Bromate []Bromide ?Bromie []Phosphate, Ortho
<br />rgan
<br />c
<br />ompoun
<br />creen, p
<br />,
<br />o
<br />a
<br />Dissolved Solids, Chloride, Fluoride, []Chlorate []Chlorite []Phosphate, Total []Bacteria in Food
<br />Alkalinity, Sulfate, Nitrate/Nitrite, Organic Carbon []Total ? Dissolved 0Sodium Adsorption Ratio Suspect:
<br />Arsenic, Barium, Calcium, Chromium, ?UV @ 254 Solids []Dissolved []Settleable Suspect:
<br />Magnesium
<br />Selenium
<br />Sodium
<br />Iron Total Coliform Rule Microbiolo %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) 0Sulfate metals (list):
<br />VOC screen. []Total Coliform (Multiple Tube enumeration) []Sulfide -
<br />[]Metals Scan: (Aluminum, Arsenic, ?Coliform, Fecal (Multiple Tube enumeration) []Turbidity
<br />Barium, Beryllium
<br />Cadmium
<br />Calcium ?Heterotrophic Plate Count []Other Inorganic: []Unknown Substance
<br />,
<br />,
<br />,
<br />Chromium
<br />Co
<br />er
<br />Iron
<br />Lead []Other Microbiology: - Identification (FTIR)
<br />,
<br />pp
<br />,
<br />,
<br />,
<br />Magnesium
<br />Man
<br />anese
<br />Mol
<br />bdenum
<br />,
<br />g
<br />y
<br />,
<br />,
<br />Nickel
<br />Potassium
<br />Selenium
<br />Silver -- -
<br />- -
<br />,
<br />,
<br />,
<br />,
<br />Sodium, Uranium, Zinc
<br />CHAIN OF CUSTODY:
<br />RELINQUISHED BV: DATE/TIME: RECEIVE DATE/TIME:
<br />RELINQUISHED BY: DATE/TIME: RECEIVED Y: r 9 T MF ?/X G
<br />Q
<br />f V
<br />RELINQUISHED BV: DATE/TIME: RECEIVED B DA
<br />E IME:
<br />LSD Interent Address: http://www.cdphe.state.co.us/lr/lrhom.htrn Report #250Req
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