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81( Svstem ID ENV-2011001852
<br />US Collection Date 2/17/2011 12:40:0OPM
<br />Control Number 5
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<br />OF ubli eAh
<br />dL_ ' amoit
<br />REQUEST FOR ANALYTICAL SERVICES
<br />Collection No:
<br />[I o111111 F1
<br />CustomerlD : 00009830
<br />Collected:
<br />Time o
<br />n? X a.m
<br />b&uf
<br />Name : Department of Natural Resources L _ LLl p,rn
<br />Address : 1313 Sherman Street Roo m 215 month day v ear hour
<br />C min
<br /> Collected by : Water Type:
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<br />c7phW
<br />Denver CO 80203
<br />City/St/Zip '
<br />Phone : 303-866-3567 Purpose: F1 Routine E] Special Purpose Repeat
<br />Email:
<br />Contact : Berhan Keffelow Compliance [:] Personal Information
<br />Fax:
<br />SAMPLE Chlorine residual: 0.00 mg/L Water Temperatu re 0C
<br />'WS ID: Coo ? ? Fluoride m9/L
<br />System Name: Temperatu re at Receipt:
<br />Address' Comments:
<br />Ot un State Ip
<br />Description:
<br />ek,
<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 Packag
<br />? BOD ?CBOD ?DO
<br />?VOCs Screen
<br />(Coliform Bacteria, Nitrate/Nit e) sticides []Chemical Oxygen Demand (COD) ?SVOCS/Pesticide
<br />2,
<br />[]Expanded Annual Colora r tracted) []Chloride _ _Screen- -
<br />Package (Coliform Bacteria, rbi ' s_ -OCMnrine '- ?BTEX
<br />Nitrate/Nitrite, pH?)S) c Compounds (VOCs)
<br />& []Chromium, hexavalent (Cr') Radiochemistry
<br />[]General Colorado Package Semla
<br />ganic Compounds (SVOCs) ?Corrosivity (Lang lier) ?GrossAlpha/Beta
<br />(Arsenic, Coliform Bacteria, Hardnes sticides Cyanide ? Direct ? Distilled []Radium 226
<br />Copper, Fluoride, Iron, Lead, ntracted) ? WAD []Radium 228
<br />Nitrate/Nitrite, Uranium) []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 []Magnesium
<br />Adsorption Ratio, Sulfate, Total Lead and Copper Rule Manganes Molybdenum Foodod Testing n
<br />Dissolved Solids, Uranium, Zinc) []Lead and Copper ? Ice 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 []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 />[]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 ? 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. Coll) Conductance []Soils/Filters - XRF
<br />[]Drilling Baseline Package without ?E. coli (Enumerated, w/ Total Coliform) ASulfate metals (list):
<br />VOC screen. []Total Coliform (Multiple Tube enumeration)
<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
<br />Iron
<br />Lead []Other Microbiology: Identification (FTIR)
<br />,
<br />,
<br />,
<br />Magnesium
<br />Manganese
<br />Molybdenum
<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: DA /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.htin Report #250Req
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