DEP WTC sample records, Oct 2001

NYC 9/11 Public Portal Document

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

Sample Type (circle one): A.B- cG)E. (1. Potable 3. Non Potable Treated : / Bottle #s: 2X55........... ' . 2. Non Potable 4. Other _ Chain of Custody? yes _ no Time/Date Collected:. Collected By: / •/ /V 7 20v_ — Agency Code:__________ Comments: PWS _ __________ Source ID: Type Descriptor: Collected From:/ACousTG -o. Bill to: Location's/Individual’s Name ileuioteavoty Name/Company Street .......................................... ..................._.. . ... .................................. Street .......... _—. 04 City/St/Zip ............................. ................ City/St/Zip _ ------- - Identification of Source _ Phone#:Fax#: i■ 50901—/

Collection Point______________ CA,CH,Bl?_--Check*_ Amoui — ------------------------------------ , ....... BACTERIOLOGICAL ANALYSIS ORGANIC POTABLE ANALYSIS _ ORGANIC NONPOTABLE/SOLID Lab#: _ Lab#:___________________________ (circle tests) 4 — I ’ (J mmmmme : (circle tests) — : e n•— ummmnes <

1. Heterotrophic Plate 1. 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 6. Pesticides (507) 6. PCB’s (Arochlors) (608/8081) 6. Macroscopic / ■ 7.Pesticides/PCB screen (508) 7. Methoprene (616)

0 Refrigerated? yes no 8. PCB as Decachlorobiphenyl (508A) 9. Herbicides (515) 10. Pesticides (525) 8. Herbicides (EPA1978/8151) 10. pXtel^HyXcfrbonScan (310-13)

11. Carbamate Pesticides (531) 11. Glycols Chlorinated:? ves 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. Purgeable Aromatics (DEF) 16. Pesticides (SM18/6630) pH 17. Petroleum/Hydrocarbon Scan (310-13) 17. Pesticides/PCB’s (DEF) 18. Other: 18. Other: .............................. — ------ - INORGANIC ANALYSIS REQUESTED - Lab#: (circle tests) ro0 S % —

1. Color 20. Acidity 39. Aluminum 59. Potassium “ ' 2. Turbidity 21. Alkalinity, as CaCO3 40. Antimony 60. Selenium ( L 22. Bromide 41. Arsenic 61. Silver / 3. pH 4. Conductivity 23. Bromate/Chlorate/Chlorite 42. Barium 62. Sodium 5. Corrosivity (temp:. °C) 24. Chloride 25. Cyanide : 5 43. Beryllium 44. Boron 63. Thallium ■ 64. Vanadium 6. BOD (5 day) 7. Soluble BOD (5 day) 26. Fluoride 45. Cadmium 65. Zinc 8. Carbonaceous BOD (5 day) 27. Hardness, Total as CaCOs 46. Calcium, as CaCO3 : 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 TCLP daGolids, Suspended 34. Phosphorus Total as P 53.Lead 71.TCLP-Mstals WSolids, Total 54 Magnesium 17. Solids, Total Dissolved 35. Phosphorus, Ortho as P 36. Sulfates 55 Manganese 72. TCLP-Pesticides 73. TCLP-Herbicides 18. Solids, Total Volatile 37. Surfactants 56. Mercury 74. TCLP-Volatiles 19- Other: _ 38.UV254 • is 57 Molybdenum— 4 75.TCLPBNAs 58. Nickel - ■ : ; )

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