Document fragment from DEP Box 19 folder 22470-22496

NYC 9/11 Public Portal Document

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM jester rovcom WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 (914) 593-5575 (9 NYS-ELAP No. 10108 Time/Date Set: Form A-70 (rev.1/96)

ple Type (circle one): C/Potable 3. Non Potable Treated Bottle #s: . 657 2. Non Potable -4. Other s ,________ Chain of Custody? /yes no Time/Date Collected: Collected By:_________ 2//2// Agency Code: /6.224 Comments: _ Source ID: .Type Descriptor Collected From: Bill to: Location’s/Individual’s Name 29/44 /7220/ PSAC Name/Company Street_________________ Street________ City/St/Zip City/St/Zip Identification of Source ■ . Phone#: Fax# Collection Point omBX3 - 1 t 0.. CA,CH, Bl? Check#: Amounts. 72 $3 BACTERIOLOGICAL ANALYSIS ' ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLID ANALYSIS Lab#: .______ • _____ _____ (circle tests) (circle tests) i." 1. Heterotrophic Plate 1. Trihalomethanes (524) 1. Purgeable Halocarbons (624/8260) Count (hemodialysis & all others) U 2. Volatile Halocarbons (524) 2. Purgeable Aromatics (624/8260) 2. Coliform P/A (public supplies) 3. Volatile Aromatics (524) 3. Acrolein & Acrylonitrile (624) 3. Coliform MPN (privwell, 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. Methoprene (616) 7API Cher:______ ;____ Q Pesticides/PCB screen (508) PCB as Decachlorobiphenyl (508A) 9. Herbicides (515) 8. Herbicides (EPA1978/8151) 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. 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; J mg/L 15. Haloacetic Acids (552) 15. Purgeable Halocarbons (DEF) Total Chlorine Res: 16. Purgeable Aromatics (DEF) 16. Pesticides (SM18/6630) pH 17. Petroleum/Hydrocarbon Scan (310-13) 17. Pesticides/PCB’s (DEF) § 18. Other__________________________ 18. Other____________ a C

INORGANIC ANALYSIS REQUESTED - Lab#: (circle tests) 1. Color 20. Acidity 39. Aluminum 59. Potassium 2. Turbidity 21. Alkalinity, as CaCOs 40. Antimony 60. Selenium 3. pH 22. Bromide 41. Arsenic 61. Silver 4. Conductivity 23. Bromate/Chlorate/Chlorite 42. Barium 62. Sodium 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 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-violatHes 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 10Sollids. Suspended 34. Phosphorus Total as P 53.Lead 71 .TCLP-Metals WSollids. Total 35. Phosphorus, Ortho as P 54 Magnesium 72.TCLP-P6sticides 17. Solids, Total Dissolved 36. Sulfates 55 Manganese 73. TCLP-Herbicides 18. Solids, Total Volatile 37. Surfactants 56. Mercury 74. TCLP-Volatiles 19. Other__________ _ 38. UV254 57 Molybdenum 75. TCLP-BNA’S 58. Nickel ‘N. .-1' =-n at, vw*.nd=l*.*2 NYC-WTC_000025703