Sample submission form, Aug 2001

NYC 9/11 Public Portal Document

■2 stchester — 93 I "i ■ ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTV * APMATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 :

(914)593-5575 "uas" 35 , i / c 4. It ) , . j NYS-ELAPNo. 10108 ime/Date Set: 003 ‘ / , ; i /< / Form A-70 (rev. 1/96) ....

■ Mi le Type (circle one): - 33 V 1; Potable 3. Non Potable Treated Bottle #‘s: 24s 1 0 I IQ II 6 e“71 V 13 2 70 ■ 1_ ( / J r * ' ,

2. Non Potable 4. Other.. ._____ Chain of Custody?.. —yes___ no Time/Date Collected: 7 33 6 / 6 4 / h/ol Comments: ... 1111" Collected By: (: z■------. Ad ■ ’ Agency Code: PWS #: ______ Source ID: —___ —Type Descriptor:____ Collected From: Bill to: Location’s/Individual’s Name G0.Dis Name/Company ___________ _____________________________ Street 14 Street____ __ City/St/Zip — Phone#: * 207 Identification of Source _ Fax#:. Collection Point CA ,4- 00 1. CA,CH, Bl? Check#: Amounts ORGANIC POTABLE ANALYSIS _0 ( BACTERIOLOGICAL ANALYSIS ORGANIC NONPOTABLE/SOLID ANALYSIS Lab#:___ _____ __ _________ ____ _ (circle tests) --- 77 (circle tests) 1. Heterotrophic Plate 1) Trihalomethane s.(524) ( A) 1. Purgeable Halocarbons (624/8260) Count (hemodialysis & all others) Volatile Halocarbons (524)/) 2. Purgeable Aromatics (624/8260) 2. Coliform P/A (public supplies) 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 Macroscopic 6. Pesticides (507) (7) Pesticides/PCB screen (508) 1 6. PCB’s (Arochlors) (608/8081) 7.' Methoprene (616) .API s. ger -_ _______ (9) Herbicides (515) * ICRa . Pocaotnd mtnl : t-3)

(10, Pesticides (525) eer 8.' Herbicides (EPA1978/8151) 9. Pesticides (SM18/6630) 10. Petroleum Hydrocarbon Scan (310-13) Remgerated? _... yes.. _ In:

Chlorinated:? ____ yes____ no (11 Carbamate Pesticides (531)_ (12. Glyphosate (547) 11. Glycols 12. Acid Extractables (625/8270) *3 Diquat (549) 13. Base Neutral Extractables (625/8270) i Free Chlorine Res: ...... mg/L 14. Chlorination Disinfection Byproducts (551) 14. GC/MS Semivolatile Unknown Scan 1.00 Total Chlorine Res:_______ _ mg/L 15. Haloacetic Acids (552) 15. Purgeable Halocarbons (DEF) 16. Pesticides (SMI8/6630) 16. Purgeable Aromatics (DEF) 1 7. Petroleum/Hydrocarbon Scan (310-13) 17. Pesticides/PCB's (DEF) IH 18. .Other:... GH LLLD . ' 18. Other:.

INORGANIC ANALYSIS REQUESTED - Lab#: I 20. Acidity 39. Aluminum 59. Potassium ■J 2. Turbidity 21. Alkalinity, as CaCO3 40. Antimony 60. Selenium | ( 3. pH 22. Bromide 41. Arsenic 61. Silver S14 Conductivity 23. Bromate/Chlorate/Chlorite 42. Barium 62. Sodium 7 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 CaCO3 28. Nitrogen, Ammonia as N 46. Calcium, as CaCOs 47.Calcium, Ca * - CLP 9. Chemical Oxygen Demand 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 31. Nitrogen, Total Kjeldahl as N 50. Cobalt 1 12. Total Organic Halides ■ 13. Solids, Percent (%) 32. Oil an Grease 51. Copper 69. Pesticides/PCB’s 70. Disk Deliverables 14. Solids, Settleable 33, Phenol 52. Iron TCLPA 3 - 15. Solids, Suspended 34. Phosphorus Total as P 53.Lead 71 TCLP-Metals tolids. Total 35. Phosphorus, Ortho as P 54 Magnesium 16 LI ’ I w • : 1Solids, Total Dissolved 36. Sulfates 55 Manganese 73. TCLP-Herbicides 18. Solids, Total Volatile 37. Surfactants 56. Mercury 119. Other a 38.UV254--- 57 Molybdenum 58. Nickel / fPMs* . . h: P NA; i

NYC-WTC_000025784