NYC 9/11 Public Portal Document
AhesTer ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM
“govcom WESTCHESTER COUNTY LABORATORIES AND RESEARCH
2 Dana Road, Valhalla, New York 10595
(914) 593-5575
NYS-ELAP No. 10108
Time/Date Set: Form A-70 (rev.1/96)
Skpietype (circle one):
0320,1513,*s$3,91S,9st0
(Potable 3. Non Potable Treated Bottle #s: 2sy +,351%, 65U6 8 3 S, n20?
2. Non Potable 4. Other Chain of Custody? yes no
Time/Date Collected: 4/251200/--- -- sspan. Comments:
Collected By: > ■ AgAgency Code: PWS#:_______ Source ID: Type Descriptor
Collected From: / Bill to:
Location’s/ndividuar’s Name luBuleserork Name/Company _
Street____________ Street________
City/St/Zip_________ City/St/Zip_____
Identification of Source' . 4 Phone#: Faxif
Collection Point B58 —-helcach,m— ii -
Checki
■ - ............ .
Amounts ' 2597
i Li .............
BACTERIOLOGICAL ANALYSIS
Lab#:
(circle tests)
4*
+
onganicrorap==AM""2o
(circle tests) C2.PT0
*
'
ORGANIC NONPOTABLE/SOLID ANALYSIS
*
*
1. Heterotrophic Plate 1 Trihalomethanes (524) . —1. "Purgeable Halocarbons (624/8260) Ps
i- >
Count (hemodialysis & all others) (2. Volatile Halocarbons (524) 2. Purgeable Aromatics (624/8260) 9./
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) 1
4. Fecal Coliform (an 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)
G— 8. PCB as Decachlorobiphenyl (508A)
9. Herbicides (515)
(10) Pesticides (525)
8. Herbicides (EPA1978/8151)
9. Pesticides (SM18/6630)
10. Petroleum Hydrocarbon Scan (310-13),
.
Refrigerated? yes no
: 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 Adds (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#:
T
C
(circle tests) •-C —5
1. Color 20. Acidity 39. Aluminum i. Potassium . -
2. Turbidity 21. Alkalinity, as CaCOs 40. Antimony 60. Selenium * / /
3. pH 22. Bromide 41. Arsenic 61. Silver ‘
4. Conductivity 23. Bromate/Chiorate/Chlorite 42. Barium 62. Sodium
5. Corrosivity (temp: °C)
24. Chloride
25. Cyanide
43. Beryllium
44. Boron
63. Thallium
6. BOD (5 day) 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.Seml-vlolatiles
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
14. Solids, Settleable 33. Phenol 52. Iron
TCLP
(Sollids. Suspended 34. Phosphorus Total as P 53.Lead
71 .TCLP-Metals
Bollids. Total 35. Phosphorus, Ortho as P 54 Magnesium
36. Sulfates 55 Manganese 72.TCLP-Pesticides
17. Solids, Total Dissolved
37. Surfactants 56. Mercury 73.TCLP-Herbicldes
18. Solids, Total Volatile
19. Other___________ 38. UV254 57 Molybdenum 74. TCLP-Volatiles
75.TCLP-BNA’s
58. Nickel .
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NYC-WTC_000026613
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