NYC 9/11 Public Portal Document
WTOWB*
HI
ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM
WESTCHESTER COUNTY LABORATORIES AND RESEARCH 15
2 Dana Road, Valhalla, New York 10595
(914) 593-5575 NYS-ELAP No. 10108
Tme/Date Set: _________________ _____ Form A-70 (rev. 1/96)
Sple Type (circle one): 8638 < 8lt 1,30/8, 6S92, 8587
1) Potable 3. Non-Potable Treated Bottle #7341,1032,1530, 0410.0042 8S80
r * t
2. Non-Potable 4. Other . ____________________ Chain of Custody?. yes .no
Time/Date Collected: 9/29/200/ _ Comments:____
Collected By: V OsS/ le V Agency Code:-------------
_ .Source ID:. .Type Descriptor:.
Collected From: Bill to:
Location's/Individual’s Name. MAAit Name/Company.
....................................................... ... ...... .. .. Street
City/St/Zio ______________ :________________ City/St/Zip______ _
Identification of Source. Dt CABA Phone#_ Fax #_
Collection Point 29050 26936
CA,CH, BI?. ■ Check#:. Amounts,
BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES , . ORGANIC NONPOTABLE/SOLID ANALYSES
. v. , • .- **
Lab#: ■ ; ' > . Lab #: . 9 24/) • ‘ . ... 2 • 841 j
(circle tests)
1. Heterotrophic Plate
4 (circle tests) C
1. Trihalomethanes (524)
. C f e 1. Purgeable Halocarbons (624/8260)
Count (hemodialysis & all others) 2. Volatile Halocarbons (524) 2. Purgeable Aromatics (624/8260) s
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) E3
4. Fecal Coliform (all samples) 5. Microextractables (504) 5. Organochlorine Pesticides (608/8080) , .
5. Microscopic . . , 6., Pesticides (507) 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)
Bebther: • ■ .____ 9, Herbicides (515) 9. Petroleum Hydrocarbon Scan (310-13)
< 10. Pesticides (525) ’ 10. Glycols in Water
Refrigerated? yes_____ no 11. Carbamate Pesticides (531) 11. Acid Extractables (625/8270) -
12. Glyphosate (547) 12. Base Neutral Extractables (625/8270) —
Chionnated?: ves no 13. Diquat (549) 13. GC/MS Unknown Scan
14. Chlorination Disinfection Byproducts (551) 14. Purgeable Halocarbons (DEF)
Free Chlorine Res:. -ma/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)
—------- hr H t i
w <.
ff4 22.17
1. Color 20. Acidity ■' 39. Aluminum L 59. Potassium
2. Turbidity 21. Alkalinity, as CaCO3 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 i
6. BOD (5 day)
7. Soluble BOD (5 day)
25. Cyanide
26. Fluoride
44. Boron
45. Cadmium
64. Vanadium
65. Zinc
4
8. Carbonaceous BOD (5 day) 27. Hardness, Total as CaCOa 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 TCLP
Colids, Suspended 34. Phosphorus. Total as P 53. Lead 71. TCLP-Metals
To. 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
... ... ■ ismsn=hi==/antm - Moimmitiaaia . _- epekdansia
NYC-WTC_000026616
OCR can misread numbers and units. Confirm readings against the page image before using them.