NYC 9/11 Public Portal Document
ENVIRONMENTAL SERVICES SAMPLE SUBMISSION. FOHM
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lest AAmU***;
WESICHFSTER COUNTY 1 ABOLATORIS ANP RCSARCI
2 D’ana Road, Valhalla, New York 10595 t»4”o
(914)593-5575 • CB547/300
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NYS-ELAP No. 10108
1! (Date Set_______________ _________ EPti * < ‘ ‘*) 3 <4 t ■ Form A-70 (rey, 1/96)
Sample Type (circle one): " *.6 "4.5 " ' ... ) 2 (( -)~T70
cy 200$2)-
"1 Potable/ 3. Non-Potable Treated Bottle #‘s:00,64-DSS22- 22-245,244
2. Non-Potable 4. Other________________ _ ________ -Chain of Custody? . ...__yes_... .... noe a F 2 6 / 3 2 2447
Time/Date Collected: _L5 OL. -0_____ ____ _ _ Comments;___
Collected By.5 T on A* uaa..Agency Code:_______ PWS #:__ ___ Source ID: Type Descriptor:
Collected From: Bill to:
Location’s/Individual’s Name tC - oe D _ ___ __ Name/Company.
Street. t 4esn LAEC o12 " A Street ___ ___________
Cy/Svzip_Mallalk— A— -------------
.Fax#:,.......
Identification of Source------======= -- ----------------------------- ------ Phone#:___ __ —_
Collection Poi~G.; ’ =)t(tCA,CH,BR?- Check#: _ . ,
/
Amounts
[BACTERIOLOGICAL ANALYSES ORGANIC PQTABLE ANALYSES ORGANIC NONPOTABLE/SOLID ANALYSES
| Labi....... .......... ...................... ........
Lab#:... 2_ _ ____ __ -
(crcio tests) (circle tests) t $
1. Heterotrophic Plate (1 T rihalomethanes (524) vL‘ s 1. Purgeable Halocarbons (624/8260)
2. Volatile Halocarbons (524) / 22 2. Purgeable Aromatics (624/8260)
Count (hemodialysis & all others)
2. Cofform P/A (public supplies) (3.) Volatile Aromatics (524) / 3. Acrolein & Acrylonitrile (624)
3. Coliform MPN (cHv well, raw. stp) 4. Total Trihalomethane Potential (510) s- 4. Phthalates (606/8060)
4. Fecal Coliform (all samples) d S. /Microextractables (504) 5. Organochlorine Pesticides (608/8080)
5. Microscopic 6, . Pesticides (507) . 6. PCB's (Arochlors) (608/8080)
6. Macroscopic 4 7.Pesticides/PCB screen (508) 7 Herbicides (SM-18/6640; 8151)
APL 8. PCB as Decachlorobiphenyl (508A) 8. Other Pesticides (SM-18/6630)
her 70 ( 92 Herbicides (515) "9. Petroleum Hydrocarbon Scan (310-13)
( 10.Pesticides (525) 10. Glycols in Water
R e f r i y e i a t e d ?_____ yes_____ no ,11. Carbamate Pesticides (531) 11. Acid Extractables (625/8270)
(12 Glyphosate (547) 12. Base Neutral Extractables (625/8270)
Chlonnated": .....yes_____ no (.13. Diquat (549) 13. GC/MS Unknown Scan
I 14. Chlorination Disinfection Byproducts (551) 14. Purgeable Halocarbons (DEF)
Free Chionme Res__ - rg/L 15. Haloacetic Acids (552) 15. Purgeable Aromatics (DEF)
16. Other Pesticides (SM-18/6630) 16. Pesticides (DEF)
Total Chlorine Res: mg/L 17. Petroleum/Hydrocarbon Scan (310-13) 17. PCB's (Arochlors) (DEF)
_PH. S*P, /6/3 u ■
_ __
FINORGANIC ANALYSES REQUESTED - Labl 2
)—
(circle tests)
1. Color 20. Acidity (39 Aluminum /59, Potassium
2. Turbidity 21. Alkalinity, as CaCOa 40. •Antimony | 60. Selenium
i 3. pH 22. Bromide 41. Arsenic 61. Silver <
j 4. Conductivity **23. Bromate/Chlorate/Chlorite 42; Barium 62. Sodium
5 Corrosivity (temp:______ "C) 24. Chloride 63. Thallium
6. BOD (5 day) 25. Cyanide ;
' 43/ Beryllium
2T Boron 64. Vanadium
7. Soluble BOD (5 day) 26. Fluoride (45) Cadmium 65/Zinc ________
8. Carbonaceous BOD (5 day) 27. Hardness, Total as CaCO3 46. Calcium, as CaCO,
(47) Calcium, Ca*2
CLP—
9. Chemical Oxygen Demand 28. Nitrogen, Ammonia as N 66. Metals/CN
10. Dissolved Oxygen 29. Nitrogen, Nitrate as N sl Chromium, Total 67. Volatiles
11. Total Organic Carbon 30. Nitrogen, Nitrite as N 49. Chromium, Hexavalent 68. Semi-volatiles
12. Total Organic Halides 31. Nitrogen, Total Kjeldahl as N 50, Cobalt 69. Pesticides/PCB’s
13. Solids, Percent (%) 32. Oil and Grease * 51J Copper 70. Disk Deliverables
s Solids, Settjeable 33, Phenol el 52. Iron TCLP
'. Solids. Suspended 34. Phosphorus. Total as P 53. Lead 71. TCLP-Metals
1 16. Sclids, Total 35. Phosphorus, Ortho as P 54. Magnesium / k J 1 Po tie i.lcl
55. Manganese 73. TCLP-Herbicides
t
1.7. Solids, Total Dissolved
18. Soids. Total Volatile _
19. Other: AC2 Pl S, 1
36. Sulfates
37. Surfactants
38.UV254 158.
57/Molybdenum
■ Mercury 74. TCLP-Volatiles
75. TCLP-BNA's .
1 Nickel
NYC-WTC_000025695
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