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Laboratory Services Division
<br />8100 Lowry Boulevard, Denver, CO 80230-6928
<br />}1 ' US Mail: PO Box 17123, Den,
<br />(303) 692-3090 fax (303) ; System ID ENV-2010001088
<br />0 oar Collection D.-te
<br />of Pub H th Control Number 14
<br />Lnd E ameat
<br />RE UEST FOR ANALYTICA ?
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<br />customerw : 00009830
<br />
<br />Name : Department of Natural Resources
<br />Collected:
<br />Time
<br />1111-1111 _ 110 1111 ...LIE El a.m
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<br />Address : 1313 Sherman Street Roo m 215 month day year hour m?
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<br />Collected by
<br />: Water Type: f f
<br />City/St/Zip : Denver CO 80203
<br />Phone : 303-866-3567 Purpose: ? Routine Special Purpose Repeat
<br />Email:
<br />Contact : Berhan Keffelow ? Compliance [:] Personal Information
<br />Fax:
<br />SAMPLE Chlorine residual: 0.00 m Water Temperature
<br />9/L DC
<br />PWS ID: coo a ? ? ? ? ? Fluoride /L
<br />1100 m
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<br />System Name: 4 1 Me' I P -
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<br />Address:
<br />Comments:
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<br />Description: T U + , bt S alzt?
<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 ? 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*s) - -Radiochemistry
<br />?General`Colorado Package- -C]Semivolatile Organic Compounds (SVOCs) ?Corrosivit (Langlier) []Gross Alpha/Beta
<br />(Arsenic, Coliform Bacteria, Hardness, ?Carbamate Pesticides Direct ? Distilled []Radium 226
<br />Copper, Fluoride, Iron, Lead, ?Diquat (Subcontracted) ? WAD []Radium 228
<br />Nitrate/ Nitrite, Uranium) ?Endothall []Uranium
<br />[]Deluxe Colorado Package ?Glyphosate 0Hardness ?C-14
<br />(Alkalinity, Arsenic, Cadmium, Calcium, Inorganic Chemicals Rule 0Mercury []Radon
<br />Coliform Bacteria, Chloride, []Pri
<br />etal b, As, Ba, Be, Cd, Cr, Hg, Individual Metals []Aluminum ?Ni-63
<br />Conductivity, Copper, Corros' ity, 92%
<br />
<br />Fluoride, Hardness, Iron, Le -
<br />1) luoride
<br />QNa
<br />I
<br />e s (S a, Be, Cd, Cr, Hg,
<br />1 ..6
<br />[]Antimony []Arsenic []Barium
<br />[]Beryllium []Cadmium []Calcium
<br />[]Gamma Spectrometr
<br />Specific Isotopes (list):
<br />Magnesium, Manganese, /, I)
<br />n Cyanide []Chromium []Cobalt []Copper
<br />Nitrate/ Nitrite, pH, Sodium, odium Nitrogen, []Nitrate ? rite []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 0 Nitrate/Nitrite ? Total Kjeldahl
<br />Sulfate, Gross Alpha/Beta) Disinfection B roducts []Nitrate ? Nitrite _
<br />[]Mining Baseline Package without []Total Trihalomethanes (TTHMs) ?pH []Mercury
<br />Gross Alpha/Beta ?Haloacetic Acids (HAA5s) 0Phenol Metals (list):
<br />[]Drilling Baseline Package (Volatile ?Alkalinity Phosphorus _
<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 ? Dissolved []Sodium Adsorption Ratio Suspect:
<br />Arsenic, Barium, Calcium, Chromium, ?UV @ 254 Solids []Dissolved []Settleable Suspect:_
<br />Iron, Magnesium, Selenium, Sodium Total Coliform Rule Microbiolo /Bacteria []Suspended []Total []Volatile Miscellaneous
<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) 0Turbid ity
<br />Barium, Beryllium, Cadmium, Calcium, OHeterotrophic Plate Count []Other Inorganic: []Unknown Substance
<br />Chromium, Copper, Iron, Lead, []Other Microbiology: Identification (FTIR)
<br />Magnesium
<br />Manganese
<br />Molybdenum
<br />,
<br />,
<br />,
<br />Nickel
<br />Potassium
<br />Selenium
<br />Silver
<br />,
<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: CoOF ZAJE/TJM?
<br />?p
<br />RELiNQUISHED BY: DATE/TIME: RECEIVED BY: DATE/TIME:
<br />LSD Interent Address: http://www.cdphe.state.co.us/Ir/lrhom.htm Report 9250Req
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