NYC 9/11 Public Portal Document
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ster ENVIRONMENTAL services Sample submission form:
v.com WESTCHESTER COUNTY LABORATORIES AND RESEARCH
da 2 Dana Road, Valhalla, New York 10595
(914) 593-5575
. NYS-ELAP No. 10108
Time/Date Set: Form A-70 (rev. 1/96)
pie Type (circle one): 150, 85/0,85,200 ,9/43
otable 3. Non Potable Treated Bottle #s:3/83,199* 1092, 0 349,00/2,0032
2. Non Potable 4. Other___________________ Chain of Custody? yes no
Time/Date Collected: _ ________________ __ J /u Comments:
Collected By: KAG71/7/ AoAaencv Code: _ Source ID: .Type Descriptor:
Collected From: . Bill to:
Location’s/Individual's Name. Hillvewlsevore Name/Company
Street ______________________________________ Street________
City/St/ZIp_______________________________________ _
Identification of Source______________________________ Phone#:______ Fax#:
Collection Point ___ 8y68------------------ CA,CH, Bl? Check#: Amounts.
BACTERIOLOGICAL ANALYSIS ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLID ANALYSIS
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) 73. 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 / 77. Pesticides/PCB screen (508) 7. Methoprene (616)
s v -8. PCB as Decachlorobiphenyl (508A)
9. Herbicides (515)
8. Herbicides (EPA1978/8151)
9. Pesticides (SM18/6630)
A MO Pesticides (525) 10. Petroleum Hydrocarbon Scan (310-13)
Refrigerated? yes no . ' —1. Carbamate Pesticides (531) 11. Glycols
Chlorinated:? yes no ‘ . 12. Glyphosate (547) 12. Acid Extractables (625/8270)
; A13. Diquat (549) 13. Base Neutral Extractables (625/8270)
Free Chlorine Res: ;^, • mg/L 1* '14. Chlorination Disinfection Byproducts (551) 14. GC/MS Semivolatile Unknown Scan
Total Chlorine Ressrer" mg/L." 5 fig; Haloacetic Acids (552) 15. Purgeable Halocarbons (DEF)
pH ig ' i 4s 417. Petroleum/Hydrocarbon Scan (310-13)
Pesticides (SM18/6630) 6 16. Purgeable Aromatics (DEF)
17. Pesticides/PCB's (DEF) y
Ba ,%. „ 18. Other jtoliaam—— ‘
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18. Other_____________________ __
INORGANIC ANALYSIS REQUESTED - Lab#: / 2,0
(circle tests) *
1. Color 20. Acidity 39. Aluminum , 59. Potassium
2. Turbidity) 1 . 21. Alkalinity, as CaCOs 40. Antimony 60. Selenium
3. pH y 763 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.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 34. Phosphorus Total as P 53.Lead TCLP
08. Solids, Total 54 Magnesium 71 .TCLP-Metals
35. Phosphorus, Ortho as P
17. Solids, Total Dissolved 36. Sulfates 55 Manganese 72. TCLP-Pesticides
37. Surfactants 56. Mercury 73.TCLP-Herbicides
18. Solids, Total Volatile 74. TCLP-Volatiles
19. Other________________ 38. UV254 57 Molybdenum
58. Nickel
75.TCLP-BNA‘s
NYC-WTC_000026353
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