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<br />Colorado Dgwment
<br />of'PARpHealth
<br />and Environment
<br />Laboratory Services Division
<br />8100 Lowry Boulevard, Denver, CO 80230-6928
<br />US Mail: PO Box 17123, Denver, CO 80217
<br />(303) 692-3090 fax (303) 344-9989
<br />System ID
<br />Collection Date
<br />Control Number
<br />ENV-2010005511
<br />5/13/2010 9:10:OOAM
<br />67
<br />REQUEST FOR ANALYTICAL SERVICES
<br />• SPECIMEN'INFORMATION
<br />CustomerID :
<br />00009830 ?
<br />E© [n o Da ? a.m
<br />Collected: Time
<br />6E
<br />Depart
<br />Name: Department of Natural Resources _
<br />-
<br />?f o p.m
<br />Address : 1313 Sherman Street Room 215 month day year hour min
<br /> Collected by: Water Type:
<br />City/SUZip : Denver CO 80203
<br />Phone : 303-866-3567 Purpose: [-] Routine E] Special Purpose Repeat
<br />Email:
<br />Contact : Berhan Keffelow
<br />Compliance F1 Personal Information
<br />Fax:
<br />SAMPLE Chlorine residual: m9/L Water Temperature
<br />°C
<br />DWS ID: Coo [] [] [] :] [? ? . ? ? ? Fluoride m9/L
<br />System Name: u
<br />Temperature at Receipt:
<br />Nddress:
<br />\t r c-fo2 C Comments:
<br />City `County State Lip
<br />~-??
<br />)escription: t" I
<br />Location Sour fi'? h -V „ "" ?„ F a r,r
<br />?Real Estate/HUD (Coliform Bacteria, COMPLIANCE DRINKING WATER TESTS InOrpaw-A- Ppd- iers 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 ?BTEX
<br />Nitrate/Nitrite, pH,_TDS)_ _ ___ . _ ?Volatile Organic Compounds (VOCs) _?Chromium, hexavalent (Cr+6) _
<br />- _Radiochemistry
<br />?General Colorado Package ?Semivolatile Organic Compounds (SVOCs) ?Corrosivit
<br />(Lang] ier) ?Gross Alpha/Beta
<br />(Arsenic, Coliform Bacteria, Hardness, ?Carbamate Pesticides Cyanide ? Direct ? Distilled ?Radium 226
<br />Copper, Fluoride, Iron, Lead, ?Diquat (Subcontracted) ? WAD ?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, Sodium Nitrogen, ?Nitrate ? Nitrite ?lron ?Lead ?Magnesium
<br />Adsorption Ratio, Sulfate, Total Lead and Copper Rule ?Manganese ?Molybdenum Food Testinq
<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 ?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 />?Drillin
<br />Baseline Packa
<br />e (Volatile ?Alkalinity Phosphorus
<br />g
<br />g
<br />Or
<br />anic Com
<br />ound Screen
<br />H
<br />Total
<br />?Bromate ?Bromide ?Bromite
<br />?Phosphate, Ortho - -
<br />g
<br />p
<br />, p
<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 />Magnesium
<br />Iron
<br />Selenium
<br />Sodium 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 Cond nce ?Soils/Filters -XRF
<br />metals (list):
<br />?Drilling Baseline Package without ?E. coli (Enumerated, w/ Total Coliform) V.Sulfate,
<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, Copper, Iron, Lead, ?Other Microbiology:
<br />- Id ication (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: DATEITIME:
<br />RELINQUISHED BY: DATEITIME: RECEIVED BY: DATEITIME:
<br />LSD Interent Address: http://www.cdphe.state.co.us/lr/lrhom.htm Report #25OReq
<br />511411b -T??
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