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Laboratory Services Division
<br />8100 Lowry Boulevard, Derv ^^-
<br />1'l US Mail: PO Box 17123, D System ID ENV-2010001087
<br />(303) 692-3090 fax (30i
<br />Collection Date
<br />Coto
<br />Of PU hfralrh Control Number 13
<br />and V..
<br />REQUEST FOR ANALYTIC
<br />L-0oDOooD
<br />CustomerlD : 00009830
<br />Collected: 0 ? a.m
<br />110 Time
<br />1111
<br />1111
<br />Vame : Department of Natural Resources -
<br />- o ? p.m
<br />Address : 1313 Sherman Street Room 215 year hour
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<br /> Collected by /
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<br />: Eft ff /I Water Type:
<br />City/St/Zip Denver CO 80203 CL1]?
<br />Phone : 303-866-3567 Purpose: E] Routine E] Special Purpose Repeat
<br />Email:
<br />Contact : Berhan Keffelow Compliance [:] Personal Information
<br />Fax:
<br />SAMPLE Chlorine residual: mg/L Water Temperatu re oC
<br />:IWS ID: coo ? 1111 ?
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<br />; Fluoride 0.1100 mg/L
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<br />Location
<br />Source a u? "'+I °-=
<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 ? BOD ?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 OBTEX
<br />Nitrate/Nitrite, pH, TDS) ?Volatile Organic Compounds (VOCs) ?Chromium, hexavalent (Cr Radiochemistry _
<br />-?Generai'Colorado Package ?Semrvolatile Orga6ic-C`Qmpounds (SVOCsF OCo`rrosivt '(CangIie'r) ?Gr& Alpha/Beta
<br />(Arsenic, Coliform Bacteria, Hardness, ?Carbamate Pesticides ?yenidegjDirect ? Distilled ?Radium 226
<br />Copper, Fluoride, Iron, Lead, ODiquat (Subcontracted) W ?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 ONi-63
<br />Conductivity, Copper, Corrosivity, Ni, Se, Na Tl) + 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 T/) + 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, Uraniu inc) []Lead and Copper []Nickel []Potassium []Selenium []Equilibrium pH
<br />?M' irn', Baseli (p Radionuclides Rule []Silver []Sodium []Strontium []Starch
<br />Nitr a/Nitrit I inu Ar n ross Alpha/Beta []Sulfur []Thallium []Tin []Fat
<br />Cad iun, Cop r, a Radium 226 []Tungsten []Uranium []Zinc []Water Activity
<br />Mag eln, M ngan e, otassium, Radium 228 Nitrogen, []Ammonia Preservatives (list):
<br />Sele ium, m, Sulfur, Uranium, Uranium ? Nitrate/Nitrite [] Total Kjeldahl - -_-
<br />Sulf e, G ssAlpha/Beta) Disinfection Byproducts []Nitrate ? Nitrite
<br />[]Mining Baseline Package without ?TotaITrihalomethanes (TTHMs) ?pH []Mercury
<br />Gross Alpha/Beta ?Haloacetic Acids (HAA5s) []Phenol Metals (list):
<br />[]Drillin
<br />Baseline Packa
<br />e (Volatile ?Alkalinity Phosphorus --
<br />g
<br />g
<br />Organic Compound Screen, pH, Total []Bromate []Bromide []Bromie []Phosphate, Ortho -
<br />Dissolved Solids, Chloride, Fluoride, []Chlorate []Chlorite []Phosphate, Total []Bacteria in Food
<br />Alkalinity, Sulfate, Nitrate/Nitrite, Organic Carbon []Total ? Dissolve d []Sodium Adsorption Ratio Suspect:- --
<br />Arsenic, Barium, Calcium, Chromium, []UV @ 254 Solids []Dissolved []Settleable Suspect:-
<br />Iron
<br />Magnesium
<br />Selenium
<br />Sodium Total Coliform Rule Microbiolo /Bacteria []Suspended []Total ?Volatile Miscellaneous
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<br />,
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<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)
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<br />Magnesium
<br />Manganese
<br />Molybdenum --
<br />-
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<br />,
<br />,
<br />Nickel
<br />Potassium
<br />Selenium
<br />Silver ---
<br />----
<br />-------- - --
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<br />,
<br />,
<br />, -- -- ---
<br />Sodium, Uranium, Zinc
<br />CHAIN OF CUSTODY:
<br />RELINQUISHED BY: _ DATE/TIME: RECEIVED BY: DATE/TIME:
<br />RELINQUISHED BY: DATE/TIME: RECEIVED BY: DA E/TIM
<br />RELINQUISHED BY: DATE/TIME: RECEIVED BY: DATE/TIME:
<br />LSD Interent Address: http://www.cdphe.state.co.us/lr/lrhom.htm Report #250Req
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