NYC 9/11 Public Portal Document
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ElNVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM
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Ge/DateSet:____
WESTCHESTER COUNTY LABORATORIES AND RESEARCH
2 Dana Road, Valhalla, New York 10595
____________________
(914) 593-5575
*
.___________________ Form A-70 (rev. 1/96)
NYS-ELAP No. 10108
Sample Type (circle one): - 14t013/0, 0335,7501,0043
1) Potable 3. Non-Potable Treated Bottle w=:8683, 65/0 2694 2622 7(2,289
2. Non-Potable. 4. Other— ___________,____ Chain of Custody? yes .no
Time/Date Collected9/25200//032___ 2 ' Comments:_____
Collected By: - H .PAT% L Agency Code:
PWS#:_________ .Source ID:. Type Descriptor
Collected From: . _ " Bill to:
Location’s/lndividuafs _ _____________________________ A Name/Company
Street__________ ' " Street__________
Ciy/SVZi_ City/St/Zip______
Identification of Source +*gi"t
Collection Point - : . ■ 521S0
DtPLAD./
24089
Phone#:, • . —Fax#
Check#:. .Amounts.
CA, CH, BI?
.i m.
BACTERIOLOGICAL ANALYSES s ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLE/SOLID ANALYSES
l ah#: rsomfr i 7 Lab _ ■ • ■■ .j -
T. Heterotrophic Plate 4 1 ‘ E • ;““Rtfalorneinanes(524)
(circle tests) ‘S/H
1. Purgeable Halocarbons (624/8260)
Count (hemodialysis & all others), ( 22 Volatile Halocarbons (524) #
2. Coliform PIA (public supplies) ”27 ( 37 Volatile Aromatics (524)
2. . Purgeable Aromatics (624/8260)
3. Acrolein & Acrylonitrile (624)
3. Coliform MPN (priv well, raw, stp) 4. Total Trihalomethane Potential (510) 4. Phthalates (606/8060) -
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4. Fecal Coliform (all samples) 5. Microextractables (504) 5. Organochlorine Pesticides (608/8080)'
5. Microscopic '. 2 i , :6. Pesticides (507) : 6. PCB’s (Arochlors) (608/8080) e.l
6. Macroscopic.'. $7 , Z.Pesticides/PCB screen (508) 7. Herbicides (SM-18/6640; 8151)
7. API - * 5 8. PCB as Decachlorobiphenyl (508A) 8. Other Pesticides (SM-18/6630)
wr-=??7 9. Herbicides (515)
। ^Pesticides (525)
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9. Petroleum Hydrocarbon Scan (310-13) .
10. Glycols in Water
Refricerafed? ves no 11. Carbamate Pesticides (531) 11. Acid Extractables (625/8270)
12. Glyphosate (547) 12. Base Neutral Extractables (625/8270)
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Chlorinated?: ■ ves no 13. Diquat (549) ' / 13. GC/MS Unknown ___
_________ Scan
14. Chlorination Disinfection Byproducts (551) 14. Purgeable Halocarbons (DEF)
Free Chlorine Res:_ _ “mg/L 15. Haloacetic Acids (552) z 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#:
23697
+53656) ph*
(circle tests)
1. Color 20. Acidity 39. Aluminum 59. Potassium
2. Turbidity 21. Alkalinity, as CaCOs 40. Antimony 60. Selenium
3. pH 22. Bromide 41. Arsenic 61. Silver h
4. Conductivity 23. Bromate/Chlorate/Chlorite 42. Barium 62. Sodium tv-
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 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
• Solids, Settleable 33. Phenol 52. Iron TCLP
D Solids, Suspended 34. Phosphorus. Total as P 53. Lead 71. TCLP-Metals
16. 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: Wh______ 38.UV254 57. Molybdenum 75. TCLP-BNA’s
3 58. Nickel
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NYC-WTC_000026697
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