Document fragment from DEP Box 19 folder 22470-22496

NYC 9/11 Public Portal Document •**PrD..

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM ester pv.com WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 “E (914) 593-5575 NYS-ELAP No. 10108 Time/Date Set: Form A-70 (rev. 1/96)

iple Type (circle one): (LP otable 3. Non Potable Treated Bottle #s: 2. Non Potable 4. Other__________ Chain of Custody? • yes no Time/Date Collected: _____ ____________ _ Comments: Collected By: VV/V1 _ Agency Code: _ Source ID: .Type Descriptor Collected From: Bill to: Location’s/ndividual’s Name Kmotesl sUP Name/Company Street______________________________________ Street__________ City/St/Zip___________________ ;_______________ CIty/St/Zip Identification of Source __ ________________________ Phone# ________ Fax#: Collection Point BY58, CA.CH.Bl? - Check#: Amounts.

BACTERIOLOGICAL ANALYSIS ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLID ANALYSIS Lab#:____________________ (circle tests) 2994 1. Purgeable Halocarbons (624/8260) 1. Heterotrophic Plate 1. Trihalomethanes (524) Count (hemodialysis & all others) 2. Volatile Halocarbons (524) 2. Purgeable Aromatics (624/8260) P .$ £*. 2. Coliform P/A (public supplies) 3. Volatile Aromatics (524) 3. Acrolein & Acrylonitrile (624) 3. Coliform MPN (priv well, raw, stp) 4. Total Trihalomethane Potential (510) 4. Phthalates (625/8270) 4. Fecal Coliform (all samples) 5. Microextractables (504) . 5. Organochlorine Pesticides (608/8081) 5. Microscopic 6. Pesticides (507) 6. PCB’s (Arochlors) (608/8081) 6. Macroscopic 7.)Pesticides/PCB screen (508) 7. Methoprene (616) 8. PCB as Decachlorobiphenyl (508A) 8. Herbicides (EPA1978/8151) T> her 9. Herbicides (515) 9. Pesticides (SM18/6630) Refrigerated? yes no 10 Pesticides (525) 10. Petroleum Hydrocarbon Scan (310-13)— 11. Carbamate Pesticides (531) 11. Glycols Chlorinated:? yes no 12. Glyphosate (547) 12. Acid Extractables (625/8270) 13. Diquat (549) 13. Base Neutral Extractables (625/8270) Free Chlorine Res:. mg/L 14. Chlorination Disinfection Byproducts (551) 14. GC/MS Semivolatile Unknown Scan Total Chlorine Res: mg/L 15. Haloacetic Acids (552) 15. Purgeable Halocarbons (DEF) 16. Pesticides (SM18/6630) 16. Purgeable Aromatics (DEF) pH 17. Petroleum/Hydrocarbon Scan (310-13) 17. Pesticides/PCB's (DEF) 18. Other_______________________ 18. Other___________________

INORGANIC ANALYSIS REQUESTED - Lab#: Go ...' (circle tests) 1. Color 20. Acidity 39. Aluminum 59. Potassium c ..... 2. Turbidity 21. Alkalinity, as CaCOs 40. Antimony 60. Selenium 3. pH 22. Bromide 41. Arsenic 61. Silver i 4. Conductivity 23. Bromate/Chlorate/Chlorite 42. Barium 62. Sodium 5. Corrosivity (temp: PC) 24. Chloride 43. Beryllium 63. Thallium 6. BOD (5 day) 25. Cyanide 44. Boron 64. Vanadium 7. Soluble BOD (5 day) 26. Fluoride 45. Cadmium 65. Zinc ' 8. Carbonaceous BOD (5 day) 27. Hardness, Total as CaCOs 46. Calcium, as CaCOs CLP 9. Chemical Oxygen Demand 28. Nitrogen, Ammonia as N 47. Calcium, Ca+2 66. Metals/CN 10. Dissolved Oxygen 29. Nitrogen, Nitrate as N 48. Chromium, Total 67. Volatiles 11. Total Organic Carbon 30. Nitrogen, Nitrite as N 49. Chromium, Hexavalent 68. Semi-violatiles 12. Total Organic Halides 31. Nitrogen, Total Kjeldahl as N 50. Cobalt 69. Pesticides/PCB's 13. Solids, Percent (%) 32. Oil an Grease 51. Copper 70. Disk Deliverables 14. Solids, Settleable 33. Phenol 52. Iron TCLP a Solids, Suspended 34. Phosphorus Total as P 53.Lead 71 TCLP-Metals SSolids, Total 35. Phosphorus, Ortho as P 54 Magnesium 72.TCLP-Pesticides 17. Solids, Total Dissolved 36. Sulfates 55 Manganese 73. TCLP-Herbicides 18. Solids, Total Volatile 37. Surfactants 56. Mercury 57 Molybdenum 74. TCLP-Volatiles 19. Other________________ , 38. UV254 75.TCLP-BNAS 58. Nickel adddkdduit CSsdis NYC-WTC_000025706