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Laboratory Services Divisior
<br />AK, I 7- 8100 Lowry Boulevard, Den System ID
<br />US Mail: PO Box 17123, De Collection Date
<br />i j (303) 692-3090 fax (303 Control Number
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<br />REQ1 FOR ANALYTICAL SERVICES
<br />CustomerlD : 00009830
<br />Name : Department of Natural Resources
<br />Address : 1313 Sherman Street Room 215
<br />City/St/Zip : Denver CO 80203
<br />Phone : 303-866-3567
<br />Email:
<br />Contact : Berhan Keffelow
<br />Fax:
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<br />ENV-20 1 1003 164
<br />3/21/2011 10:35:00AM
<br />19
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<br />Collected: ®?„ I 1 I© Time ?\a.m
<br />11
<br />month day year hour min
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<br />Collected by: Water Type: Lk jS Mp??
<br />Purpose: Routine E] Special Purpose Repeat ^
<br />6.Compliance [:] Personal Information
<br />ME,—— ME Chlorine residual: [,no mg/L Water Temperature on oC
<br />PWS ID: Coo ? 110 F1 ? Fluoride mg/L
<br />System Name: /
<br />' ' Temperature at Receipt: e.
<br />Address:
<br />Comments: ? a
<br />2MV17 ,. -:D111
<br />City Dun y a e I _ - =- -
<br />Description:
<br />Location Source
<br />[]Real Estate/HUD (Coliform Bacteria,
<br />Lead
<br />Nitrate and Nitrite) COMPLIANCE DRINKING WATER TESTS
<br />O
<br />h Inorganic Parameters Organic Parameters
<br />,
<br />[]Annual Colorado Package rganic C
<br />emicals Rule
<br />?EDB/DBCP ?Alkalinity
<br />? BOD ?CBOD ?DO []Oil and Grease
<br />?VOCs Screen
<br />(Coliform Bacteria, Nitrate/Nitrite)
<br />[]Expanded Annual Colorado ?Chlorinated Pesticides
<br />[]PCBs (Subcontracted) []Chemical Oxygen Demand (COD)
<br />Chl
<br />id ?SVOCS/Pesticide
<br />
<br />Package (Coliform Bacteria,
<br />Nitrate/Nitrite,-pH, TDS) -- - 1
<br />?Chlorinated Herbicides
<br />?Volatile Org ie-Gom n or
<br />1
<br />e
<br />Chlorin
<br />r hexavalenf (C?'6) ` Screen
<br />?BTEX
<br />Rediochemisb -
<br />?General Colorado Package ?Semivolatile rganic o po
<br />V(V
<br />;n
<br />s) ty (Langlier) ?Gr
<br />Al
<br />h
<br />/B
<br />
<br />(Arsenic, Coliform Bacteria, Hardness, $
<br />i
<br />?Carbamate estiodes
<br />Cyanide ? Direct ? Distilled oss
<br />p
<br />a
<br />eta
<br />?Radium 226
<br />Copper, Fluoride, Iron, Lead, ?Diquat (Su ontract ? WAD ?Radium 228
<br />Nitrate/Nitrite, Uranium) ?Endothall ?Fluoride ?Uranium
<br />[]Deluxe Colorado Package ?Glyphosate 0Hardness ?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 ONi-63
<br />Conductivity, Copper, Corrosivity,
<br />Fluoride, Hardness, Iron, Lead, Ni, Se, Na Tl)+Fluoride
<br />?Primary Metals (Sb, As, Ba, Be, Cd, Cr, Hg, []Antimony []Arsenic []Barium
<br />[]Beryllium ? Cadmium []Calcium []Gamma Spectrometr
<br />Specific Isotopes (list):
<br />Magnesium, Manganese, Ni, Se, Na TO + 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 []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 Packagewithout
<br />
<br />' ?TotalTrihalomethanes (TTHMs) ?pH
<br />-
<br />?Mercury
<br />Gross Alpha/B
<br />eta ?Haloacetic Acids (HAA5s) ? Phenol Metals (list):
<br />?Drilling Baseline Package (Volatile ?Alkalinity Phosphorus
<br />Organic Compound Screen, pH, Total ?Bromate []Bromide ?Bromite ?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 />
<br />Arsenic, Barium, Calcium, Chromium,
<br />?UV @ 254
<br />Solids []Dissolved []Settleable - _
<br />Suspect:
<br />?
<br />Iron, Magnesium, Selenium, Sodium, Total Coliform Rule Microbiolo /Bac eria []Suspended []Total ?Volatile --_
<br />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) ulfate
<br />A metals Oist):
<br />VOC screen. []Total Coliform (Multiple Tube enumeration) ulfide
<br />[]Metals Scan: (Aluminum, Arsenic, ?Coliform, Fecal (Multiple Tube enumeration) 0Turbid ity
<br />Barium, Beryllium, Cadmium, Calcium, ?Heterotrophic Plate Count []Other Inorganic: OUnknown Substance
<br />Chromium, Copper, Iron, Lead, []Other Microbiology: Identification (FTIR)
<br />Magnesium, Manganese, Molybdenum
<br />,
<br />
<br />Nickel, Potassium, Selenium, Silver,
<br />-
<br />-___--__-
<br />---------------
<br />
<br />Sodium, Uranium, Zinc -- Y -__
<br />-- -
<br />'HAIN OF CUSTODY: _
<br />2EUNQUISHED BY:
<br /> DATE/TIME: RECEIVED BY DATE/TIM E:
<br />1 RELINQUISHED BY: DATE/TIME: RECEIVED BY: i
<br />LSD Interent Address: http://www.cdphe.state.co.us/Ir/lrhom.htin Report #25OReq
<br />ISM.-
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