NYC 9/11 Public Portal Document
V
ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM
iv.com WESTCHESTER COUNTY LABORATORIES AND RESEARCH
2 Dana Road, Valhalla, New York 10595
(914) 593-5575
NYS-ELAP No. 10108
Ete Set: Form A-70 (rev. 1/96)
7 Zus,2090, 1535,877, 0033
Sample Type (circle one):
(fPotable 3. Non Potable Treated Bottle #s: 8490,990S, 8435589/0, 8149822 >
2. Non Potable 4. Other__________ Chain of Custody? yes no
Time/Date Collected: 9/29200_________ _ Comments:
Collected By: S . Bowp _ Agency Code: _ PWS#:_______ Source ID: .Type Descriptor:
Collected From: Bill to:
PYox y
Location's/Individual's Name. Name/Company _
Street____________________________ Street________
City/St/Zip___________________ :_____ City/St/Zip
Identification of Source pep Lr # Phone#:______ Fax#;
Collection Point__ $ 15450__ 9S3 CA,CH, Bl? Check#: Amounts T)
Daxezdssun
ORGANIC HONPOnBLE/SOUPM^E&r
BACTERIOLOGICAL ANALYSIS ORGANIC POTABLE ANALYSIS
Lab#:
(circle tests)
________________
1. Heterotrophic Plate
Lab#:.______________________
(circle tests)
1.Trihalomethanes (524)
' a
1. Purgeable Halocarbons (624/8260)
??*
82 :
Count (hemodialysis & all others) 2. olatile Halocarbons (524) 2. Purgeable Aromatics (624/8260) 3
2. Coliform P/A (public supplies) 8. olatile Aromatics (524) 3. Acrolein & Acrylonitrile (624) 13
3. Coliform MPN (priv well, raw, stp) 4. Total Trihalomethane Potential (510) 4. Phthalates (625/8270) $*
4. Fecal Coliform (all samples) 5. Microextractables (504) 5. Organochlorine Pesticides (608/8081) pt •
5. Microscopic 6. Pesticides (507) 6. PCB’s (Arochlors) (608/8081)
6. Macroscopic 7.Pesticides/PCB screen (508) 7. Methoprene (616)
_____ 8. PCB as Decachlorobiphenyl (508A) 8. Herbicides (EPA1978/8151) f
9 Herbicides
40. (515)
Pesticides (525)
9. Pesticides (SM18/6630) a
10. Petroleum Hydrocarbon Scan (310-13)
Refrigerated? yes no +1. 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 Acids (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)
& 62'
18. _ __________________________ 18. Other_____________ _
-4-
129"
INORGANIC ANALYSIS REQUESTED - Lab#:
(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 /
4. Conductivity 23. Bromate/Chlorate/Chlorite 42. Barium 62. Sodium /A
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-violatiles
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
34. Phosphorus Total as P 53.Lead
TCLP
(Solids, Suspended 71 TCLP-Metals
T6. Solids, Total 35. Phosphorus, Ortho as P 54 Magnesium
36. Sulfates 55 Manganese
72. TCLP-Pesticides
17. Solids, Total Dissolved 73.TCLP-Herbictdes
18. Solids, Total Volatile 37. Surfactants 56. Mercury
74. TCLP-Volatiles
19. Other________________ 38. UV254 57 Molybdenum 75.TCLP-BNAs
58. Nickel
ss**
NYC-WTC_000026701
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