2011-11-10_HYDROLOGY - M1980244 - Laserfiche WebLink

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CustomerlD : Name: Address : City /St/Zip : Phone : Email: Contact : Fax: PWS ID : COO SW ,em Name: Address: Description:,, Laboratory Services Division 8100 Lowry Boulevard! US M il: PO Box 1712: (30692 -3090 fax Colorad'oDe art of Public and Envimiunent REQUES1 FOR ANALYT CUSTOMER SAMPLE SITE ❑Real Estate /HUD (Coliform Bacteria, Lead, Nitrate and Nitrite) ❑Annual Colorado Package (Coliform Bacteria, Nitrate /Nitrite) ❑Expanded Annual Colorado Package (Coliform Bacteria, — Nlirate /Nitrite; pH; TDST OGeneral Colorado Packa (Arsenic, Coliform Bacteria, r dress � Copper, Fluoride, Iron, Lead, Nitrate /Nitrite, Uranium) ❑Deluxe Colorado Package (Alkalinity, Arsenic, Cadmium, Calcium Coliform Bacteria, Chloride, Conductivity, Copper, Corrosivity, Fluoride, Hardness, Iron, Lead, Magnesium, Manganese, Nitrate /Nitrite, pH, Sodium, Sodium Adsorption Ratio, Sulfate, Total Dissolved Solids, Uranium, Zinc) ❑Mining Baseline Package (pH, Nitrate /Nitrite, Aluminum, Arsenic, Cadmiun, Copper, Iron, Lead, Magnesium, Manganese, Potassium, Selenium, Sodium, Sulfur, Uranium, Sulfate, Gross Alpha /Beta) ❑Mining Baseline Package without Gross Alpha /Beta ODrilling Baseline Package (Volatile Organic Compound Screen, pH, Total Dissolved Solids, Chloride, Fluoride, Alkalinity, Sulfate, Nitrate /Nitrite, Arsenic, Barium, Calcium, Chromium, Iron, Magnesium, Selenium, Sodium, Sulfur, and Uranium) ❑Drilling Baseline Package without VOC screen. ❑Metals Scan: (Aluminum, Arsenic, Barium, Beryllium, Cadmium, Calcium, Chromium, Copper, Iron, Lead, Magnesium, Manganese, Molybdenum, Nickel, Potassium, Selenium, Silver, Sodium, Uranium, Zinc) CHAIN OF CUSTODY: RELINQUISHED BY: RELINQUISHED BY: RELINQUISHED BY: COMPLIANCE DRINKING WATER TESTS Organic Chemicals Rule ❑EDB /DBCP ❑Chlorinated Pesticides ❑PCBs (Subcontrac ❑C •r' _ -d He gaiti. le Or. . Compounds (SVOCs) C. ate Pesticides ODiquat (Subcontracted) ❑Endothall ❑Glyphosate Inorganic Chemicals Rule OPrimary Metals (Sb, As, Ba, Be, Cd, Cr, Hg, Ni, Se, Na TI) + Fluoride ❑Primary Metals (Sb, As, Ba, Be, Cd, Cr, Hg, Ni, Se, Na TI) + Fluoride + Cyanide Nitrogen, ❑Nitrate ❑ Nitrite Lead and Copper Rule ❑Lead and Copper Radionuclides Rule ❑Gross Alpha /Beta ❑Radium 226 ❑Radium 228 ❑Uranium Disinfection Byproducts OTotal Trihalomethanes (TTHMs) ❑Haloacetic Acids (HAA5s) ❑Alkalinity ❑Bromate . ❑Bromide ❑ Bromie ❑Chlorate ❑Chlorite Organic Carbon ❑Total ❑ Dissolved ❑UV @ 254 Total Coliform Rule (Microbiologv /Bacteria) ❑Total Coliform (Present/Absent, w/ E. coil) ❑E. col/ (Enumerated, w/ Total Coliform) ❑Total Coliform (Multiple Tube enumeration) ❑Coliform, Fecal (Multiple Tube enumeration) ❑Heterotrophic Plate Count ❑Other Microbiology: SPECIMEN INFORMATION DATE/TIME: DATE/TIME: DATE /TIME: Inorganic Parameters ❑Alkalinity ❑ BOD ❑CBOD ❑DO ❑Chemical Oxygen Demand (COD) ❑ Chloride ❑ Chlorine ' — B Chromium; h 6 ) — ivity (Langlier) ❑ Direct ❑ Distilled AD Fluoride ❑ Hardness ❑ Mercury Individual Metals ❑Aluminum ❑Antimony ❑Arsenic ❑Barium ❑Beryllium 0 Cadmium ❑Calcium ❑Chromium ❑Cobalt ❑Copper ❑Iron ❑Lead ❑Magnesium ❑Manganese ❑Molybdenum ❑Nickel ❑Potassium 0 Selenium ❑Silver Sodium 0 Strontium ❑Sulfur OThallium ❑Tin ❑Tungsten ❑Uranium OZinc Nitrogen, ❑Ammonia ❑ Nitrate /Nitrite ❑ Total Kjeldahl ❑Nitrate ❑ Nitrite ❑ pH ❑ Phenol Phosphorus ❑Phosphate, Ortho ❑Phosphate, Total 0 Sodium Adsorption Ratio Solids ODissolved ❑Settleable ❑Suspended ❑Total OVolatile 0 Specific Conductance ❑ Sulfate ❑ Sulfide ❑ Turbidity ❑ Other Inorganic: RECE VED B RECEIVED BY: ( i/` EE J_,,..'� RECEIVED BY: / E `'/ ESE E ("' EE�E 00009830 Department of Natural Resources 1313 Sherman Street Room 215 Denver CO 80203 303 - 866 -3567 Berhan Keffelow '&(r7D? City Coun ��k ) Location System ID Collection Date Control Number t& r I Late Zip ource ENV-2011013078 10/21/2011 12 :15 : 00 PM 25 Collected: Collected by: Purpose: U Routine 0 Compliance Chlorine residual: mg /L Water Temperature Fluoride Comments: LSD Interent Address: http:// www .cdphe.state.co.us /lr /lrhom.htm Report #250Req month day Temperature at Receipt: EL= mg /L /2' , _ , year Time hour Water Type: 0 Special Purpose Personal Information a min Repeat ❑ a.m p.m rn ❑Mercury . Metals (list): Organic Parameters ❑ and Grease ❑VOCs Screen ❑SVOCS /Pesticide Screen OBTEX R diocchem►stry ❑Gross Alpha /Beta ❑Radium 226 ❑Radium 228 ❑Uranium ❑C -14 ❑Radon ❑ N i -63 ❑Gamma Spectromel Specific Isotopes (list) Food Testing ❑Equilibrium pH ❑Starch ❑Fat ❑Water Activity Preservatives (list): ❑Bacteria in Food Suspect: Suspect: Miscellaneous ❑Soils /Filters - XRF metals (list): ❑Unknown Substance Identification (FTIR) DATE/TIME: Po iE: !, ?O DA E /TI E: