NYC 9/11 Public Portal Document
19
Time/Date Set:
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« ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM
.. WESTCHESTER COUNTY LABORATORIES AND RESEARCH
2 Dana Road, Valhalla, New York 10595
(914) 593-5575
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NYS-ELAP No. 10108
Form A-70 (rev.1/96)
Sample Type (circle one): 045s_ 1040,5225
!1. Potable 3. Non Potable Treated Bottle #s: ^1, ( 211 7 2 3 20 22 9 4242
2. Non Potable 4. Other__________ Chain of Custody? _ yes no
Time/Date Collected: 9/30/2001_____ 22:25 Ana. Comments:
Collected By: A2A/7 / aencv Code: _ Source ID: Type Descriptor
Collected From: Bill to:
Location’s/Individual’s Name Att urew QQcvorv _
Street________________ Street_________
_ City/St/Zip
Identification of Source Phone#: Fax#:
— icbonenspm ■
653
Collection Point
CA,CH, Bl? 02678
Check#:.
“Amous—
BACTERIOLOGICAL ANALYSIS ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLID ANALYSIS j,
Lab#:____________________ Lab#:______________________
(circle tests) (circle tests)
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.
8. a C Pesticides/PCB screen (508)
PCB as Decachlorobiphenyl (508A)
9. Herbicides (515)
7. Methoprene (616)
8. Herbicides (EPA1978/8151)
9. Pesticides (SM18/6630)
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)
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
mg/L 15. Haloacetic Acids (552) 15. Purgeable Halocarbons (DEF)
Total Chlorine Res:
16. Pesticides (SM18/6630) 16. Purgeable Aromatics (DEF)
pH 17. Petroleum/Hydrocarbon Scan (310-13) 17. Pestlcldes/PCB’s (DEF)
18. Other:. 18. Other________________________
INORGANIC ANALYSIS REQUESTED - Lab#:___ 6
(circle tests)
1. Color
2. Turbidity
20. Acidity
21. Alkalinity, as CaCO3
22. Bromide
39. Aluminum
40. Antimony
41. Arsenic
hder 59. Potassium
60. Selenium
61. Silver
3. pH
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 CaCOs 46. Calcium, as CaCOs 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
15lids, 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-Herbicides
18. Solids, Total Volatile 37. Surfactants 56. Mercury
38. UV254 57 Molybdenum 74. TCLP-Volatiles
19. Other________________ 75. TCLP-BNA's
58. Nickel
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NYC-WTC_000026262
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