|
Laboratory Services Division
<br />w 8100 Lowry Boulevard, Denver, CO 80230-6928
<br />US Mail: PO Box 17123 12 - 0 Q^)l?
<br />(303) 692-3090 fax, System ID
<br />A..,>..P
<br />ENV-2011003163 Collection Date 3/21/2011 10:30:00Aivt
<br />of Pubticffcalth.
<br />ald 5)i ironm t Control Number 18
<br />REQUE ITFORANALYT ? ?
<br />• 11 IL N , NUN M
<br />UVVVYOJV
<br />Name: Department of Natural Resources
<br />Collected: ®?®©
<br />© Time5E o ?a a.m
<br /> ?
<br />0 p.m
<br />Address : 1313 Sherman Street Room 215 month day year hour min
<br />
<br />City/St/Zip : Denver CO 80203 Collected by: Water Type: ff
<br />1. ?5?,
<br />Phone : 303-866-3567
<br />Email: Purpose: Routine F-1 Special Purpose Repeat
<br />Contact : Berhan Keffelow
<br />Fax: 11 Compliance F-1 Personal Information
<br />SAMPLE SITE Chlorine residual: 0-no mg/L Water Temperature 00 o
<br />C
<br />PWS ID: coo ? ? ? ? ? ? Fluoride [ 111FImg/L
<br />System Name:
<br />i3
<br />Temperature at=R?celpt - ?
<br />= -
<br />Address: ?;
<br />
<br />it C I UIL ?"? y L Comments:
<br />city ounTy State zip
<br />A
<br />Description: L- SCrS
<br />1
<br />b1z"
<br />Location Source
<br />[]Real Estate/HUD (Coliform Bacteria,
<br />Lead
<br />Nitrate and Nit
<br />it COMPLIANCE DRINKING WATER TESTS Inorganic Parameters Organic Parameters
<br />,
<br />r
<br />e)
<br />[]Annual Colorado Package Organic Chemicals 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 />i ?SVOCS/Pesticide
<br />
<br />Package (Coliform Bacteria,
<br />?Chlorinated Herbicides or
<br />de
<br />0Chlorine Screen
<br />?BTEX
<br />Nitrate/Nitrite, pH, TD_S.)______ ?Volatile Organic-Compounds (VOCs)_ ._[]-Chromium; hexav.alent-(CT+4---- -Radiochemistry -
<br />[]General Colorado Package
<br />(Arsenic, Coliform Bacteria, Hardness, ?Semivolatile Organic Compounds (SVOCs)
<br />?Carbamate Pesticides ?Co ivity (Langlier)
<br />an' ? Direct ? Distilled ?Gross Alpha/Beta
<br />?Radium 226
<br />Copper
<br />Fluoride
<br />Iron
<br />Le
<br />d ?Di
<br />t
<br />S
<br />b
<br />,
<br />,
<br />,
<br />a
<br />, qua
<br />(
<br />u
<br />contracted) WAD ?Radium 228
<br />Nitrate/Nitrite, Uranium) ?Endothall F uoride ?Uranium
<br />[]Deluxe Colorado Package ?Glyphosate []Hardness ?C-14
<br />(Alkalinity, Arsenic, Cadmium, Calcium,
<br />Coliform Bacteria, Chloride,
<br />Conductivity, Copper, Corrosivity,
<br />Fluorid
<br />H
<br />d Inorganic Chemicals Rule
<br />?Primary Metals (Sb, As, Ba, Be, Cd, Cr, Hg,
<br />Ni, Se, Na Ti) + Fluoride ?Mercury
<br />Indiv' ?Alu Inllm
<br />? n ?Ar enic QRadon
<br />ONi-63
<br />[]Gamma Spectrometr
<br />e,
<br />ar
<br />ness, Iron, Lead,
<br />M
<br />i ?Primary Metals (Sb, As, Ba, Be, C Cr, H ?B I dmium al m Specific Isotopes (list):
<br />agnes
<br />um, Manganese, Ni, Se, Na TI) + Fluoride + Cyanide []Chro m Cobalt []Copp r
<br />Nitrate/Nitrite, pH, Sodium, Sodium Nitrogen, ?Nitrate ? Nitrite []Iron ?Lead []Magnesium
<br />
<br />Adsorption Ratio, Sulfate, Total
<br />Lead and Copper Rule
<br />[]Manganese []Molybdenum _
<br />Food_Testing
<br />Dissolved Solids, Uranium, Zinc)
<br />[]Mining Baseline Package (pH ?Lead and Copper
<br />Radionuclides Rule []Nickel []Potassium []Selenium []Equilibrium pH
<br />,
<br />Nitrate/Nitrite, Aluminum, Arsenic,
<br />?Gross Alpha/Beta []Silver []Sodium []Strontium
<br />[]Sulfur []Thallium []Tin []Starch
<br />[]Fat
<br />Cadmiun, Copper, Iron, Lead, ?Radium 226 []Tungsten ?Uranium []Zinc []Water Activity
<br />Magnesium, Manganese, Potassium,
<br />Selenium
<br />Sodium
<br />S
<br />lf
<br />U
<br />i ?Radium 228
<br />?U
<br />i Nitrogen, []Ammonia Preservatives (list):
<br />,
<br />,
<br />u
<br />ur,
<br />ran
<br />um,
<br />Sulfate, Gross Alpha/Beta) ran
<br />um
<br />Disinfection B roducts ? Nitrate/Nitrite 0 Total Kjeldahl
<br />?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, 0rtho
<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 />
<br />Iron, Magnesium, Selenium, Sodium,
<br />Total Coliform Rule Mfcrobiolo ctylBacteria)
<br />[]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) []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 []Other Inorganic: []Unknown Substance
<br />Chromium, Copper, Iron, Lead, []Other Microbiology: Identification (FTIR)
<br />Magnesium, Manganese, Molybdenum
<br />,
<br />Nickel, Potassium, Selenium, Silver
<br />?-
<br />,
<br />Sodium, Uranium, Zinc) Y -
<br />CHAIN OF CUSTODY:
<br />RELINQUISHED BY:
<br /> DATE/TIME: RECEIVED BY: DATE/TIME:
<br />RELINQUISHED BY:
<br /> DATE/TIME: RECEIVED BV: T
<br />RELINQUISHED BY: DATE/TIME: RECEIVED BY: ' DATE/TIME:
<br />41
<br />LSD Interent Address: http://www.cdphe.state,co.us/Ir/lrhom.htm Report #250Req
|