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
Ulestchestar County (914) 593-5575 NYS-ELAP No. 10108
(e/Date Set: *_________________ Form A-70 (rev. 1/96)
Sumple Type (circle one): 6000do53,8o57fo57
• 1) Potable 3. Non-Potable Treated Bottle #‘s: 00*^1 8057 e 54 7 24 (l 7 Y / •
2. Non-Potable 4. _ Chain of Custody? yes no
Time/Date Collected:9/2 _ ____________ Comments:
' Collected By: • • A0 .Agency Code: PWS _________ .Source ID:. Type Descriptor:
Collected From: BUI to: ,
Location’s/Individuars Name NQ0v t 0 u) vOrI Name/Company
Street____________ Street_________
City/St/Zip_________ _
Identification of Source. Phone# Fax #:
Collection Point," Dy 3 CA, CH, Bl? Check#: Amounts
BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLE/SOLID ANALYSES
Lab#:____________________
(circle teste)
Lab _
. (circle tests)
2% 6
1. Heterotrophic Plate 3 1. Trihalomethanes (524) 1. Purgeable Halocarbons (624/8260)
Count (hemodialysis & all others) C 2.Volatile Halocarbons (524) 2. Purgeable Aromatics (624/8260)
2. Coliform P/A (public supplies) ( 3. Volatile Aromatics (524) 3. Acrolein & Acrylonitrile (624)
3. Coliform MPN (priv well,raw, stp) “ 4. Total Trihalomethane Potential (510) 4. Phthalates (606/8060)
4. Fecal Coliform, (all samples) 5. Microextractables (504) . 5.- Organochlorine Pesticides (608/8080)
5. Microscopic , 6. Pesticides (507) V 6. , PCB’s (Arochlors) (608/8080)
6. Macroscopic ’ ( 7. Pesticides/PCB screen (508) 7. Herbicides (SM-18/6640; 8151)
7. API 8. PCB as Decachlorobiphenyl (508A) 8. Other Pesticides (SM-18/6630)
•—9= 11. Carbamate Pesticides (531)
Refrigerated? ' yes - nd *.
9. Herbicides (515)
( 10. Pesticides (525)
- , 9. Petroleum Hydrocarbon Scan (310-13)
.10. Glycols in Water
. 11. Acid Extractables (625/8270)
12. Glyphosate (547) .12, Base. Neutral Extractables (625/8270)
Chionnated?: A. yes ' no 13. Diquat(549) : 13. GC/MS Unknown Scan
14. Chlorination Disinfection Byproducts (551) .14. Purgeable Halocarbons (DEF)
Free Chiorine Res: mg/L 15. Haloacetic Acids (552) .415. Purgeable Aromatics (DEF)
16. Other Pesticides (SM-1 8/6630) . £ 16. Pesticides (DEF)
Total Chlorine Res:._ _mg/L 17. Petroleum/Hlydrocarbon
;* • * .**. . .. (310-13)
Scan • • •' • 17. PCB’s (Arochlors) (DEF)
- uy 5 • - iha
pH.
INORGANIC ANALYSES 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
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-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
g Solids. Settleable 33. Phenol 52. Iron ISLE
w Solids. 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. UV254 57. Molybdenum 75. TCLP-BNA’s
58. Nickel
NYC-WTC_000026567
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