NYC 9/11 Public Portal Document
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ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM
ster WESTCHESTER COUNTY LABORATORIES AND RESEARCH
com 2 Dana Road, Valhalla, New York 10595
(914) 593-5575
NYS-ELAP No. 10108
gate Set: 6 Form A-70 (rev. 1/96)
Sample Type (circle one):
. 1 Potable 3. Non Potable Treated Bottle #s: c 9265 ??> r ? •
2. Non Potable 4. Other___________________ _ Chain of Custody? _ yes no
Time/Date Collected: 4/0/ ______________ _ Comments:
Collected By: F. bessous C eSAaency Code: PWS#:________ Source ID: .Type Descriptor:
Collected From: Bill to:
Location’s/Individual’s Name 0 9 Name/Company
Street __________________________________ Street_________
City/St/Zip__________________________________ _ Citv/St/Zi
Identification of Source ~S4 0*f 1A6 " Phone#: _ ______ Fax#:
Collection Point____ 4 30 so/ 2359s 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) 22,olatile Halocarbons (524) 2. Purgeable Aromatics (624/8260)
2. Coliform P/A (public supplies) 2,3, Volatile Aromatics (524) 3. Acrolein & Acrylonitrile (624)
3. Coliform MPN (privwell, 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)
_____________________ - 8. PCB as Decachlorobiphenyl (508A) 8. Herbicides (EPA1978/8151)
9. Herbicides (515) 9. Pesticides (SM18/6630)
Refrigerated?. yes no ( 10) Pesticides (525) 10. Petroleum Hydrocarbon Scan (310-13)
* 11. Carbamate Pesticides (531) 11. Glycols
4.
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) , , 45*. . 16. Purgeable Aromatics (DEF)
pH ; 17. Petroleum/Hydrocarbon Scan (310-13) : 5 ■ 17, Pesticides/PCB’s (DEF)
: 18. Other _.NA0de)N18Other_ ' ■
% ""pu" !
", 11 19.i -
INORGANIC ANALYSIS REQUESTED - Lab#:
14 ■ ■ • " 9 .. 1. i.
220-
(circle tests)
1. Color 20. Acidity 39. Aluminum / 59.Potassium
2. Turbidity 21. Alkalinity, as CaCO3 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+Z 66. Metais/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-violatlies
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
A Solids, Settleable 33. Phenol 52. Iron
TCLP
C Solids, 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-Herblcldes
18. Solids, Total Volatile 37. Surfactants 56. Mercury
38. UV254 57 Molybdenum 74. TCLP-Volatiles
19. Other:________________ 75.TCLP-BNAs
58. Nickel
NYC-WTC_000026357
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