|
ent
<br />of pubtlcNea3th
<br />and Exoiroament
<br />Laboratory Services Division
<br />8100 Lowry Boulevard, Denver,
<br />US Mail: PO Box 17123, Denver
<br />(303) 692-3090 fax (303) 344
<br />Svstem ID ENV-2009012305
<br />Collection Date 10/26/2009 9:00:OOAM
<br />Control Number 20
<br />a
<br />REQUEST FOR ANALYTICAL SERVICES Collection No: ? E E E E E E E
<br />• - • •
<br />CustomerlD : 00009830 (? a.m
<br />Collected: ? Time o ' `
<br />Name : Department of Natural Resources -
<br />D P.m
<br />Address : 1313 Sherman Street Room 215 month day year hour min
<br /> Collected by: Water Type:
<br />City/St/zip : Denver CO 80203
<br />Phone : 303-866-3567 Purpose: ? Routine Special Purpose Repeat
<br />Email:
<br />Contact : Berhan Keffelow ? Compliance F-1 Personal Information
<br />Fax:
<br />SAMPLE Chlorine residual: mg/L Water Temperature C
<br />0
<br />PWS ID : coo [] F1 ? [ _ Fluoride 11 000 m9/L
<br />System Name:
<br />14
<br />Temperature at Receipt:
<br />Address:
<br />G Comments:
<br />city oun State Lip
<br />Description: - -
<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 []Oil and Grease
<br />[]Annual Colorado Package ?EDB/DBCP ? SOD ?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 ?BTEX
<br />Nitrate/Nitrite, pH, TDS) ?Volatile Organic Compounds (VOCs) ?Chromium, hexavalent (Cr+6) Radiochemistry
<br />- -MGenerat-Cotorado-Package -?Semivciatite-Organi'cCom'pounits-(SVOC"s) -CoTrosfjpty-(tangller)------ -[]Gross-Alpha/Beta -
<br />(Arsenic, Coliform Bacteria, Hardness, ?Carbamate Pesticides Cyanid ? Direct ? Distilled ?Radium 226
<br />Copper, Fluoride, Iron, Lead, ?Diquat (Subcontracted) 'KWAD ?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, Sodiu Nitrogen, ?Nitrate ? Nitrite []Iron []Lead []Magnesium
<br />Adsorption Ratio, Sulfate, Total Le n u/e []Manganese []Molybdenum Food Testing
<br />Dissolved Solids, Uranium, Zinc)
<br />( ?
<br />?Le a o []Nickel []Potassium []Selenium []Equilibrium pH
<br />[]Mining Baseline Package (pH Ra ucli As u1e []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 />Sulfate, Gross Alpha/Beta) Disinfection Byproducts ?Nitrate ? Nitrite _
<br />[]Mining Baseline Package without ?TotalTrihalomethanes(TTHMs) ?pH ?Mercury
<br />Gross Alpha/Beta ?Haloacetic Acids (HAA5s) ? Phenol Metals (list):
<br />[]Drilling Baseline Package (Volatile ?Alkalinity Phosphorus -
<br />
<br />Organic Compound Screen
<br />pH
<br />Total
<br />?Bromate []Bromide ?Bromie
<br />[]Phosphate, Ortho -
<br />,
<br />,
<br />Dissolved Solids, Chloride, Fluoride, []Chlorate []Chlorite []Phosphate, Total []Bacteria in Food
<br />Alkalinity, Sulfate, Nitrate/Nitrite, Organic Carbon []Total ? Dissolved []Sodium Adsorption Ratio Suspect:
<br />Arsenic, Barium, Calcium, Chromium, ?UV @ 254 Solids []Dissolved []Settleable Suspect:
<br />Iron, Magnesium, Selenium
<br />Sodium Total Coliform Rule Microbiolo /Bacteria []Suspended []Total ?Volatile Miscellaneous
<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 />Barium, Beryllium, Cadmium, Calcium, ?Heterotrophic Plate Count []Other Inorganic: []Unknown Substance
<br />Chromium
<br />Copper
<br />Iron
<br />Lead []Other Microbiology: --- Identification (FTIR)
<br />,
<br />,
<br />,
<br />,
<br />Magnesium
<br />Manganese
<br />Molybdenum ?- __
<br />,
<br />,
<br />,
<br />Nickel
<br />Potassium
<br />Selenium
<br />Silver -?--_ -
<br />----- ---- --_ ___
<br />,
<br />,
<br />,
<br />,
<br />Sodium, Uranium, Zinc - --.-?-_ _
<br />CHAIN OF CUSTODY:
<br />?
<br />RELINQUISHED BY: DATE/TIME: RECEIVED B DATE
<br />E:
<br />RELINQUISHED BY: DATE/TIME: RECEIVED AT E:'
<br />RELINQUISHED BY: DATE/TIME: RECEIVED BY: DATE E:
<br />
<br />LSD Interent Address: http://www.cdphe.state.co.us/Ir/lrhom.htin Report 9250Req j.,
<br />t°.c
<br />
|