NYC 9/11 Public Portal Document
ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM
ester
ov.com WESTCHESTER COUNTY LABORATORIES AND RESEARCH
2 Dana Road, Valhalla, New York 10595
(914) 593-5575 |
Time/Date Set: QCS /
PxPA bib 2A404— NYS-ELAP No. 10108
Form A-70 (rev.1/96)—
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table 3. Non Potable Treated Bottle #‘s: P( - "i ■ C 6*3
2. Non Potable 4. Other________________________ Chain of Custody?yes no . ‘ Go
Time/Date Collected: _______ 19 30 A 4 Comments: 7462
--------------- Fi5
Collected By: MVasslev Agency Code: _ Source ID: Type Descriptor
Collected From: Bill to:
Location’s/ndividual’s Name Ows Name/Company
Street____________________________ Street_____ _
City/St/Zip___________________ ■ ______________ City/SVZip ______ ___________________________________
Identification of Source __ _________
Collection Point 7 / CO /
/ KepiAos. . Phone#: Fax#:
• 2.290CACH.BR***Checki ■ 'Amo^#"
_____ _______ ____ : ■ a ‘A .... ( __________ 424 xdoaRert
BACTERIOLOGICAL ANALYSIS
Lab#:____________________
.
ORGANIC POTABLE ANALYSIS
Lab#:
2p"8 ! •
OFIGAN1C NONPOTABLE/SOLID ANALYSIS
S.:..
(circle tests) (circle tests)
1. Heterotrophic Plate 1.Trihalomethanes (524) 1. Purgeable Halocarbons (624/8260)
Count (hemodialysis & all others) 22.
P.oo ‘a Volatile Halocarbons (524) 2. Purgeable Aromatics (624/8260)
2. Coliform P/A (public supplies) 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)
Gr— 8. PCB as Decachlorobiphenyl (508A)
9. Herbicides (515)
TO. Pesticides (525)
8. Herbicides (EPA1978/8151)
9. Pesticides (SM18/6630)
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
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. Pesticides/PCB’s (DEF)
IS. Other----- a4L 18. Other___________________ ____
INORGANIC ANALYSIS REQUESTED - Lab#:
(circle tests)
7087
1. Color 20. Acidity 39. Aluminum 59. Potassium
2. Turbidity 21. Alkalinity, as CaCOs 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
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.CobaIt 69. Pesticides/PCB’s
13. Solids, Percent (%) 32. Oil an Grease 51. Copper 70. Disk Deliverables
14. Solids, Settleable 33. Phenol 52. Iron
TCLP
(olids. Suspended 34. Phosphorus Total as P 53.Lead
71 .TCLP-Metals
19. Solids, Total 35. Phosphorus, Ortho as P 54 Magnesium
72. TCLP-Pesticides
17. Solids, Total Dissolved 36. Sulfates 55 Manganese
73.TCLP-Herbicldes
18. Solids, Total Volatile 37. Surfactants 56. Mercury
38. UV254 57 Molybdenum 74. TCLP-Volatiles
19. Other:_ _______________ 75.TCLP-BNAs
58. Nickel
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NYC-WTC_000026266
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