NYC 9/11 Public Portal Document
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ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM
ster WESTCHESTER COUNTY LABORATORIES AND RESEARCH
iv.com
2 Dana Road, Valhalla, New York 10595
(914) 593-5575
NYS-ELAP No. 10108
Time/Date Set: Form A-70 (rev.1/96)
W pleType (circle one):
28063
63 otable
2. Non Potable
3. Non Potable Treated
4. Other j /_______________
Bottle _ _______
Chain of Custody? yes no
Time/Date Collected: 2/s/0//6/0 Comments:
Collected By: _ VA/A S Agency Code: PWS#:_______ Source ID: Type Descriptor: _
Collected From: Bill to:
Location’s/Individual’s Name 4A- 6/6c/A Name/Company
Street___________ SAALES. Street________
City/St/Zip_________ City/St/Zip
Identification of Source Phone#: Fax#
Collection Point.-2/7 3/850 CA.CH. BM*E5 checki’" " • Amounts 207
. *34 *% ■ ; =.70
raocnaa’a
BACTERIOLOGICAL ANALYSIS ORGANIC POTABLE ANAVsisHa oRGANIC NONPOTABLE/SOLID ANALYSIS
Lab#:_______________ ____ Lab#:______________ ______________________
(circle tests) (circle tests) j"
1. Heterotrophic Plate C Trihalomethanes (524) A 2 irgeable Halocarbons (624/8260)
Count (hemodialysis & all others) (2. Volatile Halocarbons ($24) 6 2. Purgeable Aromatics (624/8260)
2. Coliform P/A (public supplies) (3 Volatile Aromatics (524 _ 3. Acrolein & Acrylonitrile (624) f
3. Coliform MPN (priv well, raw, stp)
4. Fecal Coliform (all samples)
(2 Total Trihalomethane Potential (510) 4. Phthalates (625/8270)
5. Organochlorine Pesticides (608/8081
; s
5. Microscopic
6. Macroscopic
5. Microextractables (504)
& Pesticides (507) 6. PCB’s (Arochlors) (608/8081) i *2 2
Pesticides/PCB screen (508) 7. Methoprene (616)
Gr—
Refrigerated? yes no
8. PCB as Decachlorobiphenyl (508A)
9. Herbicides (515)
d0 Pesticides (525)
8. Herbicides (EPA1978/8151)
9. Pesticides (SM18/6630)
10. Petroleum Hydrocarbon Scan (310-13)'
6*
11. Carbamate Pesticides (531) 11. Glycols 2
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. Pesticldes/PCB’s (DEF)
18. Other________ ;______________ 18. Other________________________
INORGANIC ANALYSIS REQUESTED - Lab#: i
(circle tests)
1. Color 20. Acidity 39. Aluminum 59. Potasslin C -
2. Turbidity 21. Alkalinity, as CaCOs 40. Antimony 60. Seleniur i wt aosi
3. pH 22. Bromide 41. Arsenic 61. Silver ee
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 CaCO3 46. Calcium, as CaCOs CLP J
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 SO.Cobalt 69. Pesticides/PCB’s
13. Solids, Percent (%) 32. Oil an Grease 51. Copper 70. Disk Deliverables
14. Solids, Settleable 33. Phenol 52. Iron
53.Lead TCLP
lids, Suspended 34. Phosphorus Total as P
35. Phosphorus, Ortho as P 54 Magnesium
71 TCLP-Metals
lids, Total 72.TCLP-Pestlcides
17. Solids, Total Dissolved 36. Sulfates 55 Manganese
73.TCLP-Herblcides
18. Solids, Total Volatile 37. Surfactants 56. Mercury
38. UV254 57 Molyodenum 74. TCLP-Volatiles
• 19. Other________________ 75.TCLP-BNA’S
58. Nickel
_= _daddhaai
NYC-WTC_000025885
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