NYC 9/11 Public Portal Document
ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM
ter WESTCHESTER COUNTY LABORATORIES AND RESEARCH
zcom
2 Dana Road, Valhalla, New York 10595 UE
(914) 593-5575
NYS-ELAP No. 10108
ndate Set: Form A-70 (rev.1/96)
Sample Type (circle one): P.DF$,225,229,230
(Potable 3. Non Potable Treated Bottle #s: $90, 907 2,
2. Non Potable 4. Other _____________________ Chain of Custody? yes no
Time/Date Collected: 7/21/200/ 083 Comments:
Collected By. S, Broww. Agency Code: _ Source ID: .Type Descriptor
Collected From: —>> . Bill to:
Location’s/ndividuar’s Name D Name/Company
Street__________ -_________ Street________
Citv/St/Zi 4, J______ ' City/St/Zip
Identification of Source . . . . Phone#: i Fax#:
Collection Point • 820SD .1
- 1 re y CA,CH,B7.* Check#: Amounts.
‘========*====""
----1111==*=*=1=1*111---551$”---9--?----V1‘T.11*111""
BACTERIOLOGICAL ANALYSIS ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLID ANALYSIS
Lab#:____ ___
Lab#: __ .
(circle tests) (circle tests) 6 £ y
1. Heterotrophic Plate Trihalomethanes (524) 1. Purgeable Halocarbons (624/8260)
Count (hemodialysis & all others) Volatile Halocarbons (524) 2. Purgeable Aromatics (624/8260)
2. Coliform P/A (publio 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(50 .* 5. Organochlorine Pesticides (608/8081)
5. Microscopic 6. Pesticides (507) 6. PCB’s (Arochlors) (608/8081)
6. Macroscopic 2 Pesticides/PCB screen (508) 7. Methoprene (616)
8. PCB as Decachlorobiphenyl (508A) 8. Herbicides (EPA1978/8151)
Other._____ 9. Herbicides (515) 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
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)
18. Other_______________________ 18. Other.________________________
INORGANIC ANALYSIS REQUESTED - Lab#:
(circle tests)
£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 *J
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
CFolids, Settleable 33. Phenol 52. Iron *
TOPSolids, Suspended 34. Phosphorus Total as P 53Lead ICLP
64 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-BNAs
58. Nickel
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NYC-WTC_000026443
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