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' Laboratory Services Division
<br />8100 Lowry Boulevard_DP
<br />ID -201 100 1849
<br />,, System ENV
<br />2/ 17/2011 1: ?9:OOPM
<br />Cola»i Collection Date
<br />of is Ith 2
<br />vs;dEi it control Number
<br />REQUES _ Collection No: a a a ?
<br />• SPECIMEN INFORMATION
<br />CustomerlD : 00009830
<br />e : De ar ent of Natural Resources
<br />Collected: n= Q a.m
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<br />Address : 1313 Sherman Street Roo m 215 y
<br /> Collected by : Water Type:
<br />City/St/Zip Denver CO 80203
<br />Phone : 303-866-3567 Purpose: E] Routine F1 Special Purpose Repeat
<br />Email:
<br />Contact : $erhan Keffelow F1 Compliance F-1 Personal Information
<br />Fax:
<br />SAMPLE Chlorine residual: ,no mg/L Water Temperatu
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<br />. 0 re
<br />
<br />C
<br />0
<br />'WS ID:
<br />COQ 110 [1 ? ?
<br />? - 11 [1 [1
<br />Fluoride I
<br />mg/L
<br />System Name: Temperatu re at Receipt:
<br />Address: Comments: -.-
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<br />Description: _ U ! 1
<br />Location Source
<br />[]Real Estate/HUD (Coliform Bacteria, COMPLIANCE DRINKING WATER TESTS Inorganic Parameters Organic Parameters
<br />Lead, Nitrate and Nitrite) Oi ani CI emicals Rule ?Alkalinity []Oil and Grease
<br />[]Annual Colorado Pack e 000 ? BOD ?CBOD ?DO ?VOCs Screen
<br />(Coliform Bacteria, Nitrate itr' .
<br />Pesticides []Chemical Oxygen Demand (COD) ?SVOCS/Pesticide
<br />[]Expanded Annual Col ad ?
<br />tracted)
<br />N []Chloride Screen
<br />Package (Coliform Bacte .,? _ e rbicides _
<br />IorinAated-H []Chlorine ?BTEX
<br />Nitrate/ Nitrite, PH, TDS) ?Volatile Organic Compounds (VOCs) []Chromium, hexavalent (Cr's) Radiochemistry
<br />[]General Colorado Package ?Semivolatile Organic Compounds (SVOCs) (Langlier) ?Gross Alpha/Beta
<br />(Arsenic, Colifonn Bacteria, Hardness, ?Carbamate Pesticides Direct ? Distilled
<br />oy ?Radium 226
<br />Copper, Fluoride, Iron, Lead, ?Diquat (Subcontracted) ?Radium 228
<br />Nitrate/ Nitrite, Uranium) OEndothall []Fluoride []Uranium
<br />[]Deluxe Colorado Package ?Glyphosate []Hardness ?C-14
<br />(Alkalinity, Arsenic, Cadmium, Calcium, Inorganic Chemicals Rule []Mercury ORadon
<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 Spectrometry
<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 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 []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 ?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 ?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) []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 />,
<br />,
<br />Magnesium
<br />Manganese
<br />Molybdenum
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<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, *M
<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
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