NYC 9/11 Public Portal Document
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ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM
III
UJestchester County
Tme/Date Set:
WESTCHESTER COUNTY LABORATORIES AND RESEARCH
__________________ —
2 Dana Road, Valhalla, New York 10595
(914) 593-5575 NYS-ELAP No. 10108
Form A-70 (rev. 1/96)
Sample Type (circle one): 8S89. 3590. 8653, 8630, 8634
1 Potable 3. Non-Potable Treated
Bottle ws:DDS!3"40,7391,329/,09/76s91
2. Non-Potable 4. Other _____ ____________ _ Chain of Custody? yes .no
Time/Date Collected: 9/29200/ 09">
Comments:
Collected ByE basoouscs Agency Code: _ Source ID: .Type Descriptor:
Collected From: Bill to:
Location’s/Individual’s Name. PjonA Name/Company
Street______ ___ ________ Street__________ _
City/SUZio City/St/Zip______
' u(BtP LAB i
Identification of Source. Phone#: Fax#:,
Collection Point hi so 28720 CA, CH, Bl?, as
Check#: Amounts, .
1 *
BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES ORGANIC NONPOTAB YSES
Lab#:
(circle teste)
2005 —
■ ’ .. . 1 ; . ,
Lab#:
(circle tests) 2503 - W.
152 :
1. Purgeable Halocarbons (624/8260) r
1. Heterotrophic Plate .. .1. Trihalomethanes (524)
2. Purgeable Aromatics (624/8260) 2"
Count (hemodialysis & all others) ! 24 Volatile Halocarbons (524)
2. Coliform PIA (public supplies) 4.3.7 Volatile Aromatics (524) 3. Acrolein & Acrylonitrile (624) Y *
3. Coliform MPN (privwell, raw, stp) 4. Total Trihalomethane Potential (510) 4. Phthalates (606/8060) 80 s • 2e
4. Fecal Coliform (all samples) - . 5. Microextractables (504) 5. Organochlorine Pesticides (608/8080)*
5. Microscopic . .. c . > ; 6. Pesticides (507) 6. PCB's (Arochlors) (608/8080) ; 2$ •
6. Macroscopic . h (7. Pesticides/PCB screen (508) 7. Herbicides (SM-18/8640; 8151) *
7. API 8. PCB as Decachlorobiphenyl (508A) 8. Other Pesticides (SM-18/6630) . 59
_: 9. Herbicides (515) 9. Petroleum Hydrocarbon Scan (310-1 3) *
(.10. Pesticides (525) 10. Glycols in Water 24 . •
Refrigerated? yes no 11. Carbamate Pesticides (531) 11. Acid Extractables (625/8270) 2
... <
12. Glyphosate (547) 12. Base Neutral Extractables (625/8270) 5
Chionnated?: .yes no 13. Diquat (549) f f 13. GC/MS Unknown Scan r :
14. Chlorination Disinfection Byproducts (551) 14. Purgeable Halocarbons (DEF)
Free Chiorne 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)
0+
pH
INORGANICANALYSES REQUESTED - Labs
(circle tests)
-------- ir bwms
// co -
1. Color 20. Acidity 39. Aluminum 59. Potassium C
2. Turbidity 21. Alkalinity, as CaCOs 40. Antimony 60. Selenium;
3. pH 22. Bromide 41. Arsenic 61. Silver s
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 CaCO3 46. Calcium, as CaCO3 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-volatites
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
10. 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
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NYC-WTC_000026618
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