NYC 9/11 Public Portal Document
......... ....... ,
UXL4+ ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM
fee’e.ter WESTCHESTER COUNTY LABORATORIES AND RESEARCH
VCOII
"osP ■ 2 Dana Road, Valhalla, New York 10595 *
(914)593-5575 7 p
NYS-ELAP No. 10108
Time/Date Set:
6______________ ______ —7—5/8 Form A-70 (rev. 1/96)
Aldi, —
Sample Type
(Potable
(circle one):
3. Non Potable Treated Bottle s Pi* / s.
2. Non Potable 4. Other ____________ Chain of Custody? yes no ''
Time/Date Collected: -/200_S
Comments:.................................. ...... ............................
Collected By: NJN-NAKHLA . Agency Code:
PWS #: _ Source ID: Type Desci
Collected From: Bill to:
Location's/Individual's Name A=as s
Name/Company
Street ' Street _____
City/SUZip_____________ City/StZip• v _
=— ----------------------------------------
Identification of Source Phone#: _ ---------------------------- Fax#:---------------- - ----- —--------
Collection Point
40450—: .. -. .. ... ... —.... . ....... m
CA,CH, Bl? _ -_____ —9-----------
----Check#: )-5-------
________ _ Antgl,
— ----- --------------------------------------------- ,
BACTERIOLOGICAL ANALYSIS ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLID ANAL) 'SIS
Lab#:
(circle tests)
Lab#:_ ___-2/L
(circle tests) 4 5 I I I
i h a ' "" • -.997 001
. . . . . —
: / 060
1. Heterotrophic Plate jUTrihalomethanes (524) 1. Purgeable Halocarbons (624/8260)
Count (hemodialysis & all others) 2,2olatile 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 7Pesticides/PCB screen (508) 7. Methoprene (616)
Gr—
A DI
8. PCB as Decachlorobiphenyl (508A) 8. Herbicides (EPA1978/8151)
9. Herbicides (515) 9. Pesticides (SM 18/6630)
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) 9
13. Diquat (549) 13. Base Neutral Extractables (625/8270) U
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)
16. Pesticides (SM18/6630)
15. Purgeable Halocarbons (DEF)
16. Purgeable Aromatics (DEF)
pH 17. Petroleum/Hydrocarbon Scan (310-13) 17. Pesticides/PCB’s (DEF)
18. Other: 18. Other:’
INORGANIC ANALYSIS REQUESTED - Lab#:
(circle tests) - • • , »
1. Color 20. Acidity 39. Aluminum 1
2. Turbidity . 21. Alkalinity, as CaCO3 40. Antimony 60. Selenium ■ d
3. pH 22. Bromide 41. Arsenic 61. Silver ’ *4
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
27. Hardness, Total as CaC03 46. Calcium, as CaCOa /
8. Carbonaceous BOD (5 day) 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 ;
(Solids, Suspended TCLP
34. Phosphorus Total as P 53.Lead
7 1 TCLP-Metals
. Solids, Total 35. Phosphorus, Ortho as P : 54 Magnesium
72. TCLP-Pesticides
"17. Solids, Total Dissolved 36. Sulfates 55 Manganese
18. Solids, Total Volatile 37. Surfactants 56. Mercury
73.TCLP-Herbicides
38.UV254 57 Molybdenum
74. TCLP-Volatiles
19. Other: _ 75.TCLP-BNAs
58. Nickel
.. _ , yzett
NYC-WTC_000026113
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