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<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 ENV-2010005510
<br />Collection Date 5/13/2010 9:10:00AM
<br />Control Number 66
<br />REQUEST FOR ANALYTICAL SERVICES
<br />• INFORMATION
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<br />City/St/Zip : Denver CO 80203
<br />Phone : 303-866-3567 Purpose: ? Routine E] Special Purpose Repeat
<br />Email:
<br />Contact : Berhan Keffelow Compliance Ej Personal Information
<br />Fax:
<br />SAMPLE Chlorine residual: ,on rrig/L Water Temperatu re no DC
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<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
<br />(Coliform Bacteria, Nitrate/Nitrite) ?EDB/DBCP
<br />?Chlorinated Pesticides [] BOD ?. ,.QCBQD IaDO-
<br />Chi ti icalb gen D?iT kcl (COD) OVOCs Screen
<br />?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) Radiochemistry
<br />[]General Colorado Package ?Semivolatile Organic Compounds (SVOCs) ?Corrosivity (Langlier) []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 Spectromet
<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 />
<br />Nitrate/Nitrite, pH, Sodium, Sodium
<br />Nitrogen, []Nitrate ? Nitrite
<br />[]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 ?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 />[]Drilling Baseline Package (Volatile ?Alkalinity Phosphorus --
<br />__-
<br />Organic Compound Screen, pH, Total OBromate []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, Magnesium, Selenium
<br />Sodium Total Coliform Rule Microbiolo /Bacteria []Suspended []Total []Volatile Miscellaneous
<br />,
<br />,
<br />Sulfur, and Uranium) []Total Coliform (Present/Absent, w/ E. coli) ? Specific Conductance []Soils/Filters - XRF
<br />[]Drilling Baseline Package without DE. Coll (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 />,
<br />,
<br />,
<br />Nickel
<br />Potassium
<br />Selenium
<br />Silver
<br />---
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<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: DATE/TIME:
<br />RELINQUISHED BY: DATE/TIME: RECEIVED BY: - DATE/TIME:
<br />LSD Interent Address: http://www.cdphe.state.co.us/ir/lrhom.htm Report #250Req 0-9113 V14410 7
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