NYC 9/11 Public Portal Document
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ENVIRONMENTAL SEFVICES SAMPLE SUBMISSION FORM
WESTCHESTER COUNTY LABORATORIES AND RESEARCH
2 Dana Road, Valhalla, New York 10595
—99959099900—9/0(914)593-5575 NYS-ELAP No.
ime/Date Set: Form A-70 (rev. 1/96)
Sample Type (circle one)
*(29.87*7 75
370.27331. $4 70 < - ■ ‘
.1 Potable ) 3. Non Potable Treated Bottle #’s: _ _ —k
i /
2. Non Potable 4. Other Chain of Custody? ves ..... no
Time/Date Collected: _s Comments: __ __________ ___
Collected By: __ _ __ a__
Collected From: I—
..
’s Name _ ’0 /i-
r
C ty/St/Zip
(fl
SO
Phone#:__
CA,CH, BI?”
ACTERIOLOGICAL ANALYSIS ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLID ANALYSIS
b#: __ ...................... _....... _ Lab#:...... _.............- . _.. i
— ircie tests) (circle tests) — U i
Heterotrophic Plate 1 Trihalomethanes (52-1) ‘ 1. Purgeable Halocarbons (624/8260)
Count (hemodialysis & all others) 22 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 (625/8270)
4. Fecal Coliform (all samples) 5. Microextractables (504) 5/ Organochlorine Pesticides (508/8081
5. Microscopic 6. Pesticides (507) 6. PCB’s (Arochlors) (608/8081)
Macroscopic ; 7 J Pesticides/PCB screen (508) 7. Methoprene (616)
.API_ 8. PCB as Decachlorobiphenyl (508A) 8. Herbicides: (EPA1978/8151)
8. Other:........ ................... 9. Herbicides (515) . 9. Pesticides (SM18/6630)
yes___ no (10) Pesticides (525) 10. Petroleum Hydrocarbon Scan (310-13)
Refrigerated? 11. Carbamate Pesticides (531)
12. Glyphosate (547)
"11. Glycols ltmatpepo
12. Acid Extractables (625/8270) I
Chlorinated:? ___ yes___ no
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 (SMI 8/6630) 16. Purgeable Aromatics (DEF)
pH _ 17. Petroleum/Hydrocarbon Scan (310-13) 17. Pesticides/PCB’s (DEF)
18. Other:__ __ _ __________ 18. Other:_____________
=============================================
INORGANIC ANALYSIS REQUESTED - Lab#: . I
(circle tests)
/39: Aluminum
■
1. Cuiul 20. Acidity _ ! 59. Potassium
2. Turbidity 21. Alkalinity, as CaCO3 j 40.Antimony 60. Selenium
3.pH 22. Bromide | 41. Arsenic
42. Barium —
61. liver i
4. Conductivity 23. Bromate/Chlorate/Chlorite f 62. odium
5 Corrosivity (temp: °C) 24. Chloride | 43,Beryllium . | 63. hallium
6. BOD (5 day) 25. Cyanide 1 44. Boron 1 64. Vanadium
7. Soluble BOD (5 day) 26..Fluoride ’45, Cadmium 65./Zinc j
8. Carbonaceous DOD (5 day) 27. Hardness, Total as CaCOa'
28. Nitrogen, Ammonia as N
46 Calcium, as CaCOa
47:Calcium, Ca+2
ICLP
9. Chemical Oxygen Demand 66. Metals/CN
10. Dissolved Oxygen 29/Nitrogen( Nitrate as N i 48.Chromium, Total 67. Volatiles
11. Total Organic Carbon 30. Nitrogen, Nitrite as N 49. Chromium, Hexavalent 68. Semi-violatiles
12. Total Organic Halides : ' 5 . - 31. Nitrogen, Total Kjeldahl as N 50 Cobalt 69. Pesticides/PCB’s
13. Solids, Percent (%) ' ‘ ’ 32. Oil an Grease 51 Copper 70. Disk Deliverables
1 Solids) Settleable 33, Phenol _ 52 Iron ITCLP
15, Solids, Suspended 34. i nph i I 'I li :■ ' ’
35. Phosphorus, Ortho as P
53.Lead
54 Magnesium
/ I 1 Cl Ptitsi
16. Solids, Total / )P-eali
55 Manganese
17. Solids', Total Dissolved
18. Solids, Total Volatile 37, Surfactants
—38.UV254
36. Sulfates
56. Mercury
57 Molybdenum
is <■: 4 1 : :! ■
74. TCLP-Volatiles
19. Other; S 70_
| asamseereeETEEoamosedee 58 Nickel 75.TCLP-BNA's
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NYC-WTC_000026588
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