Document fragment from DEP Box 19 folder 22470-22496

NYC 9/11 Public Portal Document

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

dple Type (circle one): Quotable 3. Non Potable Treated Bottle #‘s: 7782 2. Non Potable 4. Other_____________________________ Chain of Custody? & yes no Time/Date Collected: 13 or /6/3 As Comments: Collected By: VV/ M7 Agency Code: _ Source ID: .Type Descriptor Collected From: Bill to: Location’s/Individual's Name. F/LL Name/Company Street_____________ Street____________ City/St/Zip_________ _ City/St/Zip _____ Identification of Source Phone#: Fax# Collection Point Bx62 : 50 . - dACHBizC Check#: Amounts.

BACTERIOLOGICAL ANALYSIS ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLID ANALYSIS Lab#:___________________ ___ Lab#: _ _ 210 (circle tests) 4 ‘ / (circle tests) 1. Heterotrophic Plate 1. Trihalomethanes (524) 1. Purgeable Halocarbons (624/8260) Ps Count (hemodialysis & all others) 2. Volatile Halocarbons (524) 2. Purgeable Aromatics (624/8260) 3 £rs 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) c 5. Microscopic 6 Pesticides (507) 6. PCB’s (Arochlors) (608/8081) 6. Macroscopic (7.Pesticides/PCB screen (508) 7. Methoprene (616) 7.API 8. PCB as Decachlorobiphenyl (508A) 8. Herbicides (EPA1978/8151) _ 9. Herbicides (515) 9. Pesticides (SM18/6630) (10) Pesticides (525) 10. Petroleum Hydrocarbon Scan (310-13) Refrigerated?yes no 11. Carbamate Pesticides (531) 11. Glycols Chlorinated:? yes no 12. Glyphosate (547) 12. AcidExtractables (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:________________ 1 - •

INORGANIC ANALYSIS REQUESTED - Lab#: co (circle tests) • _ 1. Color 20. Acidity 39. Aluminum 59. Potassium C 2. Turbidity 21. Alkalinity, as CaCO3 40. Antimony 60. Seleniun 3. pH 22. Bromide 41. Arsenic 61. Silver * 4. Conductivity 23. Bromate/Chlorate/Chlorite 42. Barium 62. Sodium, 2 5. Corrosivity (temp: °C) 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 CaCOa 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 iolids, Suspended 34. Phosphorus Total as P 53.Lead TCLP ws iolids, Total 17. Solids, Total Dissolved 35. Phosphorus, Ortho as P 36. Sulfates 54 Magnesium 55 Manganese 71 .TCLP-Metals 72.TCLP-Pestlcides 73.TCLP-Herblcides 18. Solids, Total Volatile 37. Surfactants 56. Mercury 74. TCLP-Volatiles 19. Other:_____________ 38. UV254 57 Molybdenum 75.TCLP-BNA's 58. Nickel . toozluka.l NYC-WTC_000025708