NYC 9/11 Public Portal Document
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MI
Ulestchester County
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ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM
WESTCHESTER COUNTY LABORATORIES AND RESEARCH
2 Dana Road, Valhalla, New York 10595
(914)593-5575 , , .
(858 ‘*l Form A-70 (rev. 1/96)
NYS-ELAP No. 10.108
"T-
Sample Type (circle one): 2623,6683,8639,8600 899
1. Potable 3. Non-Potable Treated Bomla#61,13‘S, 33,0920,005 1 8623
2. Non-Potable 4. Other. ________ —_________ Chain of Custody? yes .no
Time/Date Colledted:@23/200/AM
Comments:
Collected By: M, YAco .Agency Code: PWS #: Source ID: .Type Descriptor:
Collected From: *. n Bill to:
Location’s/lndivlduars Name All lview) C se4vor r Name/Company
Street________ _____ ____________________ ____________ Street
Cny/SvZip_________ ______ Cry/SVZip
Identification of Source’ - _____ Phone#_ Fax #:.
Collection Point . . ■ 6158
.. i*, ...2 ... .
CA, CH, BI?. Check#: Amounts.
BACTERIOLOGICAL ANALYSES i ORGANIC POTABLE ANALYSES . ORGANIC NONPOTABLE/SOLID ANALYSES
Laba: -
(circle tests).
205**
— e: > 127 s. :..
1. Heterotrophic Plate 40 • ?
-*.2332.0 : :
1. jrihalomethanes (524) . - 1. Purgeable Halocarbons (624/8260)
Count (hemodialysis & all others)— . 2. Volatile Halocarbons (524) t" 2. Purgeable Aromatics (624/8260)
2. Coliform P/A (public Supplies). 32 Volatile Aromatics (524) ■ .3. Acrolein & Acrylonitrile (624)
4
3. Coliform MPN (prhr well, raw, stp) x
4. Total Trihalomethane Potential (510) 4. Phthalates (806/8060)
4. Fecal Coliform (all samples) : 5. Microextractables (504) 5. Organochlorine Pesticides (608/8080)
5. Microscopic 2." • 6. PCB’s (Arochlors) (608/8080)
6. Macroscopic cfpposticidosscgscreen (508) <
7. Herbicides (SM-18/6640; 8151)
8. PCB as Decachlorobiphenyl (SOSA) \ ‘ 8. Other Pesticides (SM-18/6630)
7. API
her: 9, Herbicides (515) \I 9. Petroleum Hydrocarbon Scan (310-13)
/ ^Pesticides (525) ;; 10. Glycols in Water
Refrigerated? ves no *' 11. Carbamate Pesticides (531) 11. Acid Extractables (625/8270)
... 12. Glyphosate (547) 12. Base Neutral Extractables (625/8270)
Chionnated?: ves l no 13. Diquat (549) “ 13. GC/MS Unknown Scan
14. Chlorination Disinfection Byproducts (551) 14. Purgeable Halocarbons (DEF)
FreeChionne Res —ma/L15. Haloacetic Acids (552) V 15. Purgeable Aromatics (DEF)
16-Other Pesticides (SM-18/6630) 16. Pesticides (DEF)
Total Chlorine Res: mg/L 1 7. Petroleum/Hydrocarbon Scan (310-13) 1-7. PCB’s (Arochlors) (DEF)
pH
INORGANIC ANALYSES REQUESTED - Lab#:
(circle tests)
.._ - wb •
1. Color 20. Acidity 39. Aluminum ) 59. Potassium
2. Turbidity 21. Alkalinity, as CaCOa 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 CaCOa 46. Calcium, as CaCOa 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-volatiles
12. Total Organic Halides 31. Nitrogen, Total Kjeldahl as N 50. Cobalt 69. Pesticides/PCB’s
13. Solids, Percent (%) 32. Oil and Grease 51. Copper 70. Disk Deliverables
olids. Settleable , 33. Phenol 52. Iron ISLE
WS iolids. Suspended 34. Phosphorus. Total as P 53. Lead 71. TCLP-Metals
16. Solids, Total 35. Phosphorus, Ortho as P 54. Magnesium 72. TCLP-Pesticides
17. Solids, Total Dissolved 36. Sulfates 55. Manganese 73. TCLP-Herbicides
18. Solids. Total Volatile 37. Surfactants 56. Mercury 74. TCLP-Volatiles
19. Other:_____________ 38. UIV254 57. Molybdenum 75. TCLP-BNA's
58. Nickel
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NYC-WTC_000026449
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