NYC 9/11 Public Portal Document
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ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM
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WESTCHESTER COUNTY LABORATORIES AND RESEARCH
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2 Dana Road, Valhalla, New York 10596
(914) 593-5575 NYS-ELAP No. 10108
Form A-70 (rev. 1/96)
imple Type (circle one): C0035, x-8,8019,%6%8,55s%
D Potable 3. Non-Potable Treated
Bottle I’s: S81, 8675,041, 3956 YS,110
2. Non-Potable 4. Other____________ Chain of Custody? yes .no
Time/DateCollected: 9/24/o i_________ /D'O 1
Comments:
Collected By:H, Agency Code: PWS #: .Source ID: .Type Descriptor:
Collected From: Bill to:
Location's/ndividual's Name S ate n T
Name/Company
Street__________________________________ Street
City/SVZip___________________ _________ City/St/Zip
Identification of Source. ______________ ' bEPLAYH Phone*: Fax#:.
Collection Point 58 3 50: 2 8993 CA, CH, Bl? Check#: Amounts.
BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLE/SOLID ANALYSES
Lab#:
(circle tests) .
.
Labe ' 1.300
(circleteste) — Z -29
1. Trihalomethanes (524)
1. Heterotrophic Plate . 1. Purgeable Halocarbons (624/8260)
Count (hemodialysis & all. others) < 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 1080) 2
5. Microscopic ’ 1 6. Pesticides (507) PCB’s (Arochlors) (608/8080) ? 2A
6. Macroscopic • . 7. Pesticides/PCB screen (508) _ : . 7. Herbicides (SM-18/6640; 8151) ' / rti
7. AP! 8. PCB as Decachlorobiphenyl (508A) 8. Other Pesticide? (SM-18/6630) a
SOther: • _________ 9. Herbicides (515) 9. Petroleum Hydrocarbon Scan (310-13)
10. Pesticides (525) 10. Glycols in Water .
Hefriaeraka?, ' yes no 11. Carbamate Pesticides (531) 11. Acid Extractables (625/8270) *
12. Glyphosate (547) 12. Base Neutral Extractables (625/8270) yr
Chlorinated?: ves no 13. Diquat (549) 13. GC/MS Unknown Scan / •
14. Chlorination Disinfection Byproducts (551) i 14. Purgeable Halocarbons (DEF)
Free Chlorine Res:. mg/L 15. Haloacetic Acids (552) 15. Purgeable Aromatics (DEF) ’
16. Other Pesticides (SM-18/6630) 16. Pesticides (DEF)
Total Chlorine Res: .mg/L 17. Petroleum/Hydrocarbon Scan (310-13) 17. PCB’s (Arochlors) (DEF)
pH
INORGANIC ANALYSES REQUESTED - Lab#:.
(circle tests) -/
1. Color 20. Acidity 39. Aluminum 59. Potassium ' * ca
2. T urbidity 21. Alkalinity, as CaCOs 40. Antimony 60. Selenium •as
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 :________
d
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
14. Solids, Settleable 33. Phenol 52. Iron ISLE
Colids. Suspended 34. Phosphorus. Total as P 53. Lead 71. TCLP-Metals
TO.Sclids, 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-Volatlles
19. Other: - 38. UV254 57. Molybdenum 75. TCLP-BNA’s -
m 58. Nickel______________
_ .. .... 4L _tk
NYC-WTC_000026615
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