Sample submission form, Sep 2001

NYC 9/11 Public Portal Document

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

Sample Type (circle one): (Potable 3. Non Potable Treated Bottle _ _______ 099 2. Non Potable 4. Other________________ _______ Chain of Custody? res no Time/Date Collected: 7-/* -0/ 2730 Comments: Collected By: /7//7 Agency Code: _ Source ID: .Type Descriptor Collected From: Bill to: Location’s/Individual’s Name // 2 / •/& & Ase Name/Company Street______________________________________ ___ Street________ City/St/Zip___________ ________ ;__________________ City/St/Zip........ Phone#: . _ _h > . IFax# _ _=s Identification of Source______________ ______________ L Collection Point _ _ " 4**2/***19m208,98**77* ** i

CA.CH. Bl? ' m7074 Check#: f . , , b TsmEE/70 1 Amount .h*p*

BACTERIOLOGICAL ANALYSIS ORGANIC POTABLE ANALYSIS— "OnGANIC NONPOTABLE/SOLID ANALYSIS Lab#:____________________ (circle tests) 2237 * (circle tests) * ' ' 1. Heterotrophic Plate “12 Trihalomethanes (524) 1. Purgeable Halocarbons (624/8260) Count (hemodialysis & all others) 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 (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 Pesticides (507) 6. PCB’s (Arochlors) (608/8081) 6. Macroscopic 7 6 Pesticides/PCB screen (508) 8. PCB as Decachlorobiphenyl (508A) 7. Methoprene (616) 8. Herbicides (EPA1978/8151) 9. Herbicides (515) 9. Pesticides (SM18/6630) 23 10 Pesticides (525) 10. Petroleum Hydrocarbon Scan (310-13).1 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 - Total Chlorine Res: mg/L 15. Haloacetic Acids (552) 15. Purgeable Halocarbons (DEF) 1. 16. Pesticides (SM18/6630) 16. Purgeable Aromatics (DEF) pH 17. Petroleum/Hydrocarbon Scan (310-13) 17. Pesticides/PCB’s (DEF) C 18. Other_______________________ 18. Other______ '_____ • re

INORGANIC ANALYSIS REQUESTED - Lab#: (circle tests) 1. Color 20. Acidity 39. Aluminum leTLS 59. Potassium 2. Turbidity 21. Alkalinity, as CaCO3 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 / f M e f 8. Carbonaceous BOD (5 day) 27. Hardness, Total as CaCO3 46. Calcium, as CaCOs CLP I 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 Colids, Suspended 34. Phosphorus Total as P 53.Lead 54 Magnesium 71 TCLP-Metals 16. Solids, Total 35. Phosphorus, Ortho as P 72. TCLP-Pesticides 17. Solids, Total Dissolved 36. Sulfates 55 Manganese 73.TCLP-Herblcldes 37. Surfactants 56. Mercury 18. Solids, Total Volatile 19. Other:____________ 38. UV254 57 Molybdenum 74. TCLP-Volatiles 75.TCLP-BNAS 58. Nickel ' aXestola NYC-WTC_000025979