Laboratory Services Division
<br />8100 Lowry Boulevard, Denver, CO 80230 -6928
<br />US Mail: PO Box 17123, Denver, C - - --
<br />(303) 692 -3090 fax (303) 344 -�
<br />REQUEST FOR ANALYTICAL
<br />System ID ENV - 2009012310
<br />Collection Date 10/26/2009 11:05:OOAM
<br />Control Number 25
<br />CustomerlD : 00009830
<br />Name: Department of Natural Resources
<br />LL- _ 16 ©© o ]T— a.m
<br />Collected: I - I V I Time 0 p m
<br />Address : 1313 Sherman Street Room 215
<br />month d ear hour min
<br />y y
<br />City /St/Zip : Denver CO 80203
<br />Collected by: Water Type:
<br />Phone: 303 - 866 -3567
<br />Purpose: ❑ Routine ❑ Special Purpose Repeat
<br />Email:
<br />Contact : Berhan Keffelow
<br />Fax:
<br />❑ Compliance F1 Personal Information
<br />S AMPLE
<br />Chlorine residual: 0 m 9 /L Water Temperature
<br />° C
<br />PWS ID: coo ❑ ❑ ❑
<br />Fluoride 11 0110 m 9 /L
<br />System Name: C
<br />Address:
<br />2
<br />Temperature at Receipt:
<br />Comments:
<br />City County State /-Ip
<br />-
<br />Description:
<br />Location Source
<br />❑Real Estate /HUD (Coliform Bacteria,
<br />COMPLIANCE DRINKING WATER TESTS
<br />Inorganic Parameters
<br />Organic Parameters
<br />Lead, Nitrate and Nitrite)
<br />_Organic Chemicals Rule
<br />❑Alkalinity
<br />❑Oil and Grease
<br />[]Annual Colorado Package
<br />❑EDB /DBCP
<br />❑ BOD ❑CBOD ❑DO
<br />❑VOCs Screen
<br />(Coliform Bacteria, Nitrate /Nitrite)
<br />[]Chlorinated Pesticides
<br />❑Chemical Oxygen Demand (COD)
<br />❑SVOCS /Pesticide
<br />❑Expanded Annual Colorado
<br />❑PCBs (Subcontracted)
<br />❑Chloride
<br />Screen
<br />Package (Coliform Bacteria,
<br />❑Chlorinated Herbicides
<br />❑Chlorine
<br />❑BTEX
<br />Nitr /Nit rite, p H, TDS)
<br />❑Volatile Organic ComPounds_(.V_QCs) _
<br />_❑ .Chromium,- hexavalent- (Gr —L) - --
<br />- Radiochemistry
<br />-- ❑General Colorado Package
<br />❑Semivolat'ile Orga 'c Compounds (SVOCs)
<br />❑Corrosivity (Langlier)
<br />❑Gross Alpha /Beta
<br />(Arsenic, Coliform Bacteria, Hardness,
<br />❑Garb ate Pe des
<br />Cyanide ❑ Direct ❑ Distilled
<br />❑Radium 226
<br />Copper, Fluoride, Iron, Lead,
<br />iq tracted)
<br />❑ WAD
<br />❑Radium 228
<br />Nitrate /Nitrite, Uranium)
<br />❑Deluxe Colorado Package SO
<br />t
<br />lyphosate
<br />❑Fluoride
<br />❑Hardness
<br />❑Uranium
<br />❑C -14
<br />(Alkalinity, Arsenic, Cadmium, Ca um,
<br />Coliform Bacteria, Chloride,
<br />Inorganic Chemicals Rule
<br />❑Primary Metals (Sb, As, Ba, Be, Cd, Cr, Hg,
<br />❑Mercury
<br />Individual Metals ❑Aluminum
<br />[-]Radon
<br />❑Ni -63
<br />Conductivity, Copper, Corrosivity,
<br />Ni, Se, Na TI) + Fluoride
<br />❑Antimony ❑Arsenic ❑Barium
<br />❑Gamma Spectrometi
<br />Fluoride, Hardness, Iron, Lead,
<br />❑Primary Metals (Sb, As, Ba, Be, Cd, Cr, Hg,
<br />❑Beryllium ❑Cadmium ❑Calcium
<br />Specific Isotopes (list):
<br />Magnesium, Manganese,
<br />Ni, Se, Na TI) + Fluoride + Cyanide
<br />❑Chromium ❑Cobalt ❑Copper
<br />_
<br />Nitrate /Nitrite, pH, Sodium, Sodium
<br />Nitrogen, ❑Nitrate ❑ Nitrite
<br />❑Iron ❑Lead ❑Magnesium
<br />Food Testtng
<br />Adsorption Ratio, Sulfate, Total
<br />Lead and Copper Rule
<br />❑Manganese ❑Molybdenum
<br />Dissolved Solids, Uranium, Zinc)
<br />❑Lead and Copper
<br />❑Nickel []Potassium ❑Selenium
<br />❑Equilibrium pH
<br />❑Mining Baseline Package (pH,
<br />Radionuclides Rule
<br />❑Silver ❑Sodium ❑Strontium
<br />❑Starch
<br />Nitrate/ Nitrite, Aluminum, Arsenic,
<br />❑Gross Alpha /Beta
<br />❑Sulfur ❑Thallium ❑Tin
<br />❑Fat
<br />Cadmiun, Copper, Iron, Lead,
<br />❑Radium 226
<br />❑Tungsten ❑Uranium ❑Zinc
<br />❑Water Activity
<br />Magnesium, Manganese, Potassium,
<br />❑Radium 228
<br />Nitrogen, ❑Ammonia
<br />Preservatives (list):
<br />Selenium, Sodium, Sulfur, Uranium,
<br />❑Uranium
<br />❑ Nitrate /Nitrite ❑ Total Kjeldahl
<br />Sulfate, Gross Alpha /Beta)
<br />Disinfection Byproducts
<br />❑Nitrate ❑ Nitrite
<br />❑Total Trihalomethanes (TTHMs)
<br />_
<br />❑Mercury
<br />❑Mining Baseline Package without
<br />❑pH
<br />Gross Alpha /Beta
<br />❑Haloacetic Acids (HAA5s)
<br />❑Phenol
<br />Metals (list):
<br />❑Drilling Baseline Package (Volatile
<br />❑Alkalinity
<br />Phosphorus
<br />❑Bacteria in Food
<br />Organic Compound Screen, pH, Total
<br />Dissolved Solids, Chloride, Fluoride,
<br />❑Bromate ❑Bromide ❑ Bromie
<br />❑Chlorate ❑Chlorite
<br />❑Phosphate, Ortho
<br />❑Phosphate, Total
<br />Alkalinity, Sulfate, Nitrate /Nitrite,
<br />Organic Carbon ❑Total ❑ Dissolved
<br />❑Sodium Adsorption Ratio
<br />Suspect:_
<br />Arsenic, Barium, Calcium, Chromium,
<br />❑UV @ 254
<br />Solids ❑Dissolved ❑Settleable
<br />Suspect:_
<br />Iron, Magnesium, Selenium, Sodium,
<br />Total Coliform Rule Microbiolo /Bacteria
<br />❑Suspended ❑Total ❑Volatile
<br />Miscellaneous
<br />❑Total Coliform (Present/Absent, w/ E. coli)
<br />Sulfur, and Uranium)
<br />❑Specific Conductance
<br />❑Soils /Filters - XRF
<br />❑Drilling Baseline Package without
<br />VOC screen.
<br />❑E. coli (Enumerated, w/ Total Coliform)
<br />❑Total Coliform (Multiple Tube enumeration)
<br />7Silfate
<br />❑Sulfide
<br />metals (list):
<br />[]Metals Scan: (Aluminum, Arsenic,
<br />❑Coliform, Fecal (Multiple Tube enumeration)
<br />❑ Turbid ity
<br />❑Unknown Substance
<br />Identification (FTIR)
<br />Barium, Beryllium, Cadmium, Calcium,
<br />Chromium, Copper, Iron, Lead,
<br />❑Heterotrophic Plate Count
<br />❑Other Microbiology:
<br />❑Other Inorganic:
<br />Magnesium, Manganese, Molybdenum,
<br />Nickel, Potassium, Selenium, Silver,
<br />Sodium, Uranium, Zinc)�=
<br />C
<br />CHAIN OF CUSTODY;
<br />RELINQUISHED BY:
<br />DATE /TIME: RECEIVED
<br />BY: ff ALWNJP
<br />DAT E:
<br />RECEIVED BY: W' I DAT
<br />LSD Interent Address: http:// www .cdphe.state.co.us /lr /lrhom.htm Report 9250Req �p
<br />LP
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