NYC 9/11 Public Portal Document
ster ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM
com WESTCHESTER COUNTY LABORATORIES AND RESEARCH
2 Dana Road, Valhalla, New York 10595
15
(914) 593-5575
NYS-ELAP No. 10108
Time/Date Set: Form A-70 (rev. 1/96)
ample Type (circle one): P,PF%, 228,229,250
1.Potable 3. Non Potable Treated Bottle #‘s: S70,9072,(SOS,036S,n002, P
2. Non Potable 4. Other _ __________________ Chain of Custody? yes no
Time/Date Collected: 424/200 0836 Comments:
Collected By: S, Brww - Agency Code: PWS#:_______ Source ID: .Type Descriptor
Collected From: — > Bill to:
Location’s/ndividual’s Name D —____________ Name/Company
Street______ _ ______________________________ Street________
CIty/St/Zip.___________________________________ CIty/St/Zip
Identification of Source__________________________ Phone#: _ _____ Fax#
Collection Point_ 2-2DSO_________ CA,CH, BI? . Check#: Amounts.
BACTERIOLOGICAL ANALYSIS ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLID ANALYSIS
(circle ------
Lab# . . C A1
99
Lab#:___________________ _
(circle tests) tests)
1. Heterotrophic Plate 1. Trihalomethanes (524) 1. Purgeable Halocarbons (624/8260)
Count (hemodialysis & all others)
2. Coliform P/A (public supplies) 2 Volatile Halocarbons (524)
'volatile Aromatics (524)
2. Purgeable Aromatics (624/8260)
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)
8. PCB as Decachlorobiphenyl (508A) 8. Herbicides (EPA1978/8151)
oner______________ 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
22. Bromide 41. Arsenic 61. Silver
.Ss
3. pH
4. Conductivity 23. Bromate/Chlorate/Chlorite 42. Barium 62. Sodium UJ
5. Corrosivity (temp:. °C) 24. Chloride 43. Beryllium
44. Boron
63. Thallium
6. BOD (5 day) 25. Cyanide 64. Vanadium
7. Soluble BOD (5 day) 26. Fluoride 45. Cadmium 65. Zinc
C
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
S
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.Seml-violatlles 3
C
12. Total Organic Halides 31. Nitrogen, Total Kjeldahl as N 50.Cobalt 69.Pesticides/PCB’s
13. Solids, Percent (%)
14. Solids, Settleable
Colids, Suspended
32. Oil an Grease
33. Phenol
34. Phosphorus Total as P
51. Copper
52. Iron
53.Lead
70. Disk Deliverables
TCLP
t
16.Solids, Total 35. Phosphorus, Ortho as P 54 Magnesium
71 .TCLP-Metals
72.TCLP-Pesticides
03
17. Solids, Total Dissolved 36. Sulfates 55 Manganese
73. TCLP-Herbicides
18. Solids, Total Volatile 37. Surfactants 56. Mercury
57 Molybdenum
74. TCLP-Volatiles
19. Other______________ _ 38. UV254
75.TCLP-BNA’S
58. Nickel
NYC-WTC_000026436
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