NYC 9/11 Public Portal Document
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ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM
WESTCHESTER COUNTY LABORATORIES AND RESEARCH
2 Dana Road, Valhalla, New York 10595
(914) 593-5575
09
G ate Set: NYS-ELAP No. 10108
Form A-70 (rev.1/96)
Sample Type (circle one): 010 (,0063,8ss) , Zsso > 8s49 / 3Sb4
1. Votable 3. Non Potable Treated 7369,1803.7660 0302
2. Non Potable 4. Other —_____________________ Chain of Custody?yes no
TIme/Date Collected: .9/21/200 / 0855 Comments:
Collected By:B.Geds Agency Code: _ Source ID: .Type Descriptor
Collected From: T Bill to:
Location’s/Individual’s Name 8 y A' Name/Company
Street______________ _________ Street_______
‘*
Citv/StZio . } 1 4: _
y
Identification of Source” Phone# .
1 ____ Fax
Collection Point NJM24(D 6
P t
CA,CH, BI?• .Ps9 7 Check#: AmpuntS.
**
— =*=====
BACTERIOLOGICAL ANALYSIS ORGANIC POTASLE ANALYSIS 7 ORGANIC NONPOTABLE/SOLID ANALYSIS
Lab# as Wb tests) 2.320
(circle tests) 5597 $ M • _
1. Heterotrophic Plate 4 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) S. Volatile Aromatics (524) 3. Acrolein & Acrylonitrile (624)
3. Coliform MPN 4. Total Trihalomethane Potential (510) 4. Phthalates (625/8270)
4. Fecal Coliform 5. Microextractables (504) 5. Organochlorine Pesticides (608/8081)
5. Microscopic . 6. Pesticides (507) • 6. PCB’s (Arochlors) (608/8081)
6, Macroscopic A Ai (7.) Pesticides/PCB screen (508) 7. Methoprene (616)
8. ter ; 5
—
0 *g *1 $ ‘8. PCB as Decachloropiphenyl (508A)
9. Herbicides (515)
- 8. Herbicides (EPA1978/8151)
9. Pesticides (SM18/6630)
Refrigerated? yes g" Ito)Pesticides (525)
. £ r. Carbamate Pesticides (531)
10. Petroleum Hydrocarbon Scan (310-13)
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:. man 14. Chlorination Disinfection Byproducts (551) 14. GC/MS Semivolatile Unknown Scan K
Total Chlorine Res: _______ mg/L 15. Haloacetic Acids (552) 15. Purgeable Halocarbons (DEF) R
16. Pesticides (SM18/6630) 16. Purgeable Aromatics (DEF) 5
pH 17. Petroleum/Hydrocarbon Scan (310-13) 17. Pesticides/PCB’s (DEF)
18. Other._______________________ 18. Other
INORGANIC ANALYSIS REQUESTED - Lab#: 2 Pu
(circle tests) X"
1. Color 20. Acidity 39. Aluminum 59. Potassium
2. Turbidity 21. Alkalinity, as CaCO3 40. Antimony 60. Selenium
3. pH 22. Bromide -y 41. Arsenic 61. Silver
4. Conductivity 23. Bromate/Chlorate/Chlorite* 42. Barium , 62. Sodium C,
5. Corrosivity (temp:__ °C) 24. Chloride 43. Beryllium e 63. Thallium
6. BOD (5 day) 25. Cyanide 44. Boron 64. Vanadium
45. Cadmium C,
7. Soluble BOD (5 day) 26. Fluoride 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 t
13. Solids, Percent (%) 32. Oil an Grease 51. Copper 70. Disk Deliverables
JdSolids, Settleable 33. Phenol 52. Iron
CSolids, Suspended 530ead < TCLP
34. Phosphorus Total as P
16. Solids, Total 35. Phosphorus, Ortho as P 84 Magnesium $ 71 TCLP-Metals
55 Manganese *' . 72.TCLP-Pesticides
17. Solids, Total Dissolved 36. Sulfates
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
NYC-WTC_000026442
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