2011-11-10_HYDROLOGY - M1980244 - Laserfiche WebLink

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Colorado Public tt Health and Environmcnt REQUE FOR ANALY CUSTOMER SAMPLE SITE Location ❑Real Estate /HUD (Coliform Bacteria, Lead, Nitrate and Nitrite) ❑Annual Colorado Package (Coliform Bacteria, Nitrate /Nitrite) ❑Expanded Annual Colorado Package (Coliform Bacteria, — Nitrate /Nitrite7pH- TDS) - - -- - ❑G eneral Colorado Package (Arsenic, Coliform Bacteria, Hardness, 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 ❑Drilling 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. OMetals 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 TEST Organic Chemicals Rule B /DBC P lori Bs VolalWe -Org an ic-C om- pounds -( -V O Os ) ❑Semivolatile Organic Compounds (SVOCs) OCarbamate Pesticides ❑Diquat (Subcontracted) ❑Endothall ❑Glyphosate lnoraanic Chemicals Rule OPrimary Metals (Sb, As, Ba, Be, Cd, Cr, Hg, Ni, Se, Na TI) + Fluoride OPrimary Metals (Sb, As, Ba, Be, Cd, Cr, Hg, Ni, Se, Na TI) + Fluoride + Cyanide Nitrogen, ❑Nitrate ❑ Nitrite Lead and Copper Rule OLead and Copper Radionuclides Rule OGross Alpha /Beta ❑Radium 226 DRadium 228 ❑Uranium Disinfection Byproducts OTotal Trihalomethanes (TTHMs) ❑Haloacetic Acids (HAA5s) ❑Alkalinity ❑Bromate ❑Bromide ❑ Bromie ❑Chlorate ❑Chlorite Organic Carbon OTotal ❑ Dissolved ❑UV @ 254 Total Coliform Rule (Microbioloav /Bacteria) OTotal Coliform (Present/Absent, w/ E. coli) ❑E. coli (Enumerated, w/ Total Coliform) OTotal Coliform (Multiple Tube enumeration) ❑Coliform, Fecal (Multiple Tube enumeration) ❑Heterotrophic Plate Count ❑Other Microbiology: DATE/TIME: DATE/TIME: DATE/TIME: lnoraanic Parameters ❑Alkalinity ❑ BOD ❑CBOD ❑DO ❑ Chemical Oxygen Demand (COD) ❑ Chloride ❑ Chlorine = ❑.Chromium,_hexavalent (Cr +e ) ❑ Corrosivity (Langlier) Cyanide ❑ Direct ❑ Distilled ❑ WAD ❑ Fluoride ❑ Hardness ❑ Mercury Individual Metals ❑Aluminum ❑Antimony ❑Arsenic OBarium ❑Beryllium 0 Cadmium ❑Calcium ❑Chromium ❑Cobalt ❑Copper ❑Iron ❑Lead ❑Magnesium ❑Manganese ❑Molybdenum ONickel ❑Potassium 0 Selenium OSilver ❑Sodium 0 Strontium ❑Sulfur OThallium OTin ❑Tungsten ❑Uranium KZinc N itrogen, ❑Ammonia ❑ Nitrate /Nitrite ❑ Total Kjeldahl ❑Nitrate ❑ Nitrite ❑ pH ❑ Phenol Phosphorus ❑Phosphate, Ortho OPhosphate, Total 0 Sodium Adsorption Ratio Solids issolved OSettleable ❑Suspended OTotal ❑Volatile 0 Specific Conductance Sulfate ❑ ulfide ❑ Turbidity ❑ Other Inorganic: RECEIVED BY: go -- RECEIVED BY: RECEIVED BY: CustomerlD Name: Address : City /St/Zip : Phone : Email: Contact : Fax: PWS ID : coo Syst Name: Address: Description: Laboratory Services Division 8100 Lowry Boulevard+ ^° uL r r^ B.O23l -6928 US Mail: PO Box 17t (303) 692 -3090 fa: 00009830 Department of Natural Resources 1313 Sherman Street Room 215 Denver CO 80203 303 - 866 -3567 Berhan Keffelow oun ae I Urky nki Source System ID Collection Date Control Number ENV - 2011013079 10/21/2011 11:15 : 00 AM 26 Collected: Collected by: Chlorine residual: Fluoride LSD Interent Address: http:// www .cdphe.state.co.us /lr /lrhom.htm Report #250Req ? ;L - day 2 Purpose: El Routine 0 Compliance 0 Temperature at Receipt: Comments: B OO E l Special Purpose El Personal Information year mg /L I z rIs _5- Time hour Water Type: c a m /L Water Temperature 9 I/I min El Repeat m oC Organic Parameters ❑Oil and Grease ❑VOCs Screen ❑SVOCS /Pesticide Screen ❑BTEX Radiochemistry ❑Gross Alpha /Beta ❑Radium 226 ❑Radium 228 ❑Uranium ❑C -14 ❑Radon ❑ N i -63 ❑Gamma Spectromet Specific Isotopes (list) Food Testing ❑Equilibrium pH ❑Starch ❑Fat ❑Water Activity Preservatives (list): ❑Mercury Metals (list): ❑Bacteria in Food Suspect: Suspect: Miscellaneous ❑Soils /Filters - XRF metals (list): ❑Unknown Substance Identification (FTIR) DATE /TIME: a.m ❑ p.m DATE /TIME: