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<br />cnrorado Mt
<br />of Pubtic
<br />and Lnimament
<br />Laboratory Services Division
<br />8100 Lowry Boulevard, Denver, CO 80230-6928 ?i
<br />US Mail: PO Box 17123, Denver, CO 80217 System ID
<br />(303) 692-3090 fax (303) 344-9989 Collection Date
<br />Control Number
<br />ENV-2010005509
<br />5/13/2010 10:20:OOAM
<br />65
<br />REQUEST FOR ANALYTICAL SERVICES ,-
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<br />--- --- - -
<br />
<br />CLISTOMER
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<br />PECIMEN
<br />INFORMATION J L_I LJ
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<br />CustomerID: 00009830
<br />Name: Department of Natural Resources
<br />Collected:
<br />?? Time
<br />L -TI- _ 41b I& o 7 a.m
<br />Address : 1313 Sherman Street Room 215 month day year hour min p.m
<br />City/SUZip : Denver CO 80203
<br />Collected by: Re&W Water Type:
<br />Phone : 303-866-3567 Purpose: F] Routine Special Purpose Repeat
<br />Email:
<br />Contact : Berhan Keffelow
<br />Fax: Compliance Personal Information
<br />SAMPLE Chlorine residual: ,no mg/L Water Temperat
<br />0 ure
<br />°C
<br />PWS ID: Coo ? ? ? ? ? ? ? ? ? Fluoride /L
<br /> mg
<br />System Name: ,?r _
<br />
<br />Address: Temperatu re at Receipt:
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<br />Comments:
<br />i oun State Ip
<br />Description: _N 1 ' l ?t L"'
<br />_
<br />? I S i! if QAq
<br />Location Source
<br />[]Real Estate/HUD (Coliform Bacteria, COMPLIANCE DRINKING WATER TESTS Inorganic Parameters Organic Parameters
<br />Lead, Nitrate and Nitrite)
<br />[]Annual Colorado Package Organic Chemicals Rule
<br />[]EDB/DBCP ?Ilalip .t ?,, a"
<br />Ii1 BOrD e'lbW
<br />?tatBtQO []Oil and Grease
<br />
<br />(Coliform Bacteria, Nitrate/Nitrite)
<br />[]Chlorinated Pesticides .
<br />0Chemical Oxygen Demand (COD) OVOCs Screen
<br />?SVOCS/Pesticide
<br />[]Expanded Annual Colorado []PCBs (Subcontracted) 0Chloride Screen
<br />Package (Coliform Bacteria, ?Chlorinated Herbicides []Chlorine OBTEX
<br />_ N(trate/Nitrite, pH, TDS)_ , []Volatile Organic Compounds (VOCs) []Chromium, hexavalent (Cr+6) Radiochemistry
<br />[]General Colorado Package -- -OSem-ivolattle-Organic Compounds-(SV(DCs)-- =O,Corrosivity-(Langlier)._ _ ?GrossAlpha/Beta
<br />(Arsenic, Coliform Bacteria, Hardness, OCarbamate Pesticides Cyanide [] Direct ? Distilled ?Radium 226--- -
<br />Copper, Fluoride, Iron, Lead, ODiquat (Subcontracted) WWAD L/ []Radium 228
<br />Nitrate/Nitrite, Uranium) OEndothall []Fluoride ?Uranium
<br />[]Deluxe Colorado Package OGlyphosate ? 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 0 Nitrite []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, DGross 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 0 Nitrate/Nitrite 0 Total Kjeldahl
<br />Sulfate, GrossAlpha/Beta) Disinfection B roducts ?Nitrate [] Nitrite
<br />?Mining Baseline Package without []Total Trihalomethanes (TTHMs) []pH ?Mercury
<br />Gross Alpha/Beta OHaloacetic Acids (HAA5s) ? Phenol Metals (list):
<br />[]Drilling Baseline Package (Volatile []Alkalinity Phosphorus
<br />Organic Compound Screen, pH, Total []Bromate []Bromide 11 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 oliform Rule Microbiolo /Bacteria []Suspended []Total ?Volatile Miscellaneous
<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) 0Sulfate 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, Copper, Iron, Lead,
<br />Magnesium
<br />Manganese
<br />Molybdenum []Other Microbiology: flde ifi ation (FTIR)
<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: DATE/TIME: RECEIVED BY: DATE/TIME:
<br />LSD Interent Address: http://www.cdphe.state.co.us/lr/Irhom.htm Report #250Req
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