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<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 ENV-2010005511
<br />Collection Date 5/13/2010 9:10:00AM
<br />Control Number 67
<br />REQUEST FOR ANALYTICAL SERVICES _
<br />SPECIMEN INFORMATION
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<br />Address : 1313 Sherman Street Room 215 month da hour min
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<br /> Collected by: Water Type:
<br />City/St/Zip Denver CO 80203
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<br />Phone : 303-866-3567 Purpose: ? Routine F? Special Purpose Repeat
<br />Email:
<br />Contact : $erhan Keffelow kcompliance ? Personal Information
<br />Fax:
<br />SAMPLE SITE Chlorine residual: 0-no mg/L Water Temperature oC
<br />PWS ID: coo [] []
<br />[J] n EFT-1 Fluoride
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<br />L1 u u U . U mg/L
<br />System Name:
<br /> Temperature at Receipt: /jYG
<br />Address: Comments:
<br />city `oun State zip
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<br />Description:
<br />Location Sour
<br />[]Real EstateiHUD (Coliform Bacteria, COMPLIANCE DRINKING WATER TESTS In`oraani'F?a`ra?rr6t:ist 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 0Chlorine 13BTEX
<br />Nitrate/Nitrite, pH, TDS) ?Volatile Organic Compounds (VOCs) ?Chromium, hexavalent (Cr+6) Radiochemistry
<br />[]General Colorado Package OSemivolatile Organic Compounds (SVOCs) ?Corrosivity (Langlier) ?Gross Alpha/Beta
<br />(Arsenic, Colifonn 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 ONi-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 []Iron []Lead []Magnesium
<br />Adsorption Ratio, Sulfate, Total Lead and Copper Rule []Manganese []Molybdenum Food Testin
<br />
<br />Dissolved Solids, Uranium, Zinc)
<br />[]Lead and Copper
<br />[]Nickel []Potassium []Selenium g
<br />[]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 ? Nitrate/Nitrite ? Total Kjeldahl _
<br />Sulfate, Gross Alpha/Beta) Disinfection Byproducts []Nitrate ? Nitrite
<br />
<br />[]Mining Baseline Package without
<br />?TotalTrihalomethanes (TTHMs)
<br />?pH _
<br />?Mercury
<br />Gross Alpha/Beta ?Haloacetic Acids (HAA5s) []Phenol 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, wl E. coli) ? Specific Condy. nce []Soils/Filters - XRF
<br />[]Drilling Baseline Package without ?E. coli (Enumerated, w/Total Coliform) ?ulfate,? 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, OHeterotrophic Plate Count 0Other Inorganic: []Unknown Substance
<br />Chromium, Copper, Iron, Lead, []Other Microbiology: Id ' ication (FTIR)
<br />Magnesium
<br />Manganese
<br />Molybdenum _-_-_
<br />_ •
<br />,
<br />,
<br />, __
<br />_ _
<br />Nickel, Potassium, Selenium, Silver,
<br />Sodium, Uranium, Zinc
<br />CHAIN OF CUSTODY:
<br />RELINQUISHED BY: DATE/TIME: RECEIVED BY: DATE/TIME:
<br />RELINQUISHED BY: DATE/TIME: RECEIVED BY: DATE/TIME:
<br />RELINQUISHED BY: DATE/TIME: RECEIVED BY: DATE/TIME:
<br />LSD Interent Address: http://www.cdphe.state.co.us/lr/lrhom.htmReport 9250Req .? \ 5rjtb
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