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Laboratory Services Division
<br />8100 Lowry Boulevard Denver CO 80230-6-W-2
<br />U S Mall -e-? °
<br />T a " (303 ENV-2O 11001850
<br />' System ID
<br />Wo Collection Date 2/17/2011 1157:UOPM
<br />1T th'
<br />and ent Control Number
<br />REST FO ollection No: 0000E
<br />• 1_ S PECIMEN INFORMATION
<br />CustomerlD : 00009830
<br />
<br />Name : De
<br />artment of Natural Resources
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<br />Collected: ffi _ ran
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<br />Address : 1313 Sherman Street Room 215 month day year
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<br /> Collected by: Water Type:
<br />City/St/Zip : Denver CO 80203
<br />Phone : 303-866-3567 Purpose: ? Routine Special Purpose ? Repeat
<br />Email:
<br />Contact : Berhan Keffelow n Compliance E] Personal Information
<br />Fax:
<br />SAMPLE Chlorine residual: Water Temperature
<br />m /L RS o
<br />9 C
<br />PWS ID: Coo ? F1 ?
<br />El] P
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<br />Fluoride
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<br />mg/L
<br />System Name:
<br /> Temperatu re at Receipt:
<br />Address:
<br />ack
<br />
<br />Comments:
<br />City oun State zip
<br />Description:
<br />MAAAQ-
<br />Locatidn
<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 ?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) 0Chloride Screen
<br />Package (Coliform Bacteria - _?Chlorinated.Herbicides _
<br />[]Chlorine ?BTEX
<br />Nitrate/Nitrite, pH, TDS) OVolatile Organic Compounds (VOCs) []Chromium, hexavalent (Cr16) Radiochemistry
<br />[]General Colorado Package
<br />(Arsenic, Coliform Bacteria, Hardness,
<br />Copper, Fluoride, Iron, Lead, emi volatile Organic Com unds (SVOCs)
<br />arb a ci s
<br />jqu n
<br />I ivity (Langlier)
<br />yani e ? Direct ? Distilled []Gross Alpha/Beta
<br />[]Radium 226
<br />[]Radium 228
<br />Nitrate/Nitrite, Uranium) Pfd Fluoride []Uranium
<br />[]Deluxe Colorado Package lyp
<br />h t ? Hardness ?C-14
<br />(Alkalinity, Arsenic, Cadmium, Calcium, Inor anic Ch mica/. Rule 0Mercury 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 ?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 />Sulfur, and Uranium) []Total Coliform (Present/Absent, w/ E. Coll) []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) 0Turbid ity
<br />Barium, Beryllium, Cadmium, Calcium, ?Heterotrophic Plate Count 0Other Inorganic: []Unknown Substance
<br />Chromium, Copper, Iron, Lead, []Other Microbiology: Identification (FTIR)
<br />Magnesium, Manganese
<br />Molybdenum
<br />,
<br />,
<br />Nickel, Potassium
<br />Selenium
<br />Silver
<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: DATE/TIME:
<br />RELINQUISHED BY: DATE/TIME: RECEIVED BY: DATEITIME:
<br /> L?1
<br />LSD Interent Address: http://www.cdphe.state.co.us/lr/lrhom.htin Report #250Req
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