NYC 9/11 Public Portal Document
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III NC
ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM
WESTCHESTER COUNTY LABORATORIES AND RESEARCH
2 Dana Road, Valhalla, New York 10595
(914) 593,5575 j NYS-ELAP No. 10108
Time/DateSet___ 1 OTr 6-1 - ) AXe - V____ Form A-70 (rev. 1/96)
Saple Type (circle one): 2355,63s* ,c691, 9540,0918,7336 1903
1) Potable 3. Non-Potable Treated Bottle #s&2/,382 * ,824 4 28/3,88s 7 .8883
2. Non-Potable 4. Other___________________ Chain of Custody? .yes no
421/200/____ //D
Time/Date Collected Comments:
Collected By: J, LolA Agency Code:— PWS#: .Source ID:. Type Descriptor:______
Collected From: 30250, . Bill to: y
Location’s/Individual’s Name. QAHAA Name/Company
Street_________ ______ Street_________
City/St/Zip___________ City/St/Zip
Identification of Sources Owias Phone#: Fax #: i
Collection Point 2A700350
2438* CA, CH, BI? Check#: Amounts.
BACTERIOLOGICAL ANALYSES ‘ ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLE/SOLID ANALYSES
. / “2 ds9 .
Lab#. / 0 ‘ 2
• t.
Lab#:_____________________ ’ m* - ■ f
(tircte twA c. — - *5r . ■ ■
(circle tests)
1. Heterotrophic Plate 1. Trihalomethanes (524) Purgeable Halocarbons (624/8260)
Count (hemodialysis & all others) ( 2) Volatile Halocarbons (524) 2. Purgeable Aromatics (624/8260)
2. Coliform P/A (public supplies) C 3 Volatile Aromatics (524) 3. Acrolein & Acrylonitrile (624)
3. Colifdrm 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 (608/8080) 13
5. Microscopic ,6, Pesticides (507) 6. PCB's (Arochlors) (608/8080) 1.
6. Macroscopic C 7 Pesticides/PCB screen (508) 7. Herbicides (SM-18/6640; 8151) ,•
7. API 8. PCB as Decachlorobiphenyl (508A) 8. Other Pesticides (SM-18/6630)
8ther 9. Herbicides (515) 9. Petroleum Hydrocarbon Scan (310-13) C
( 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)
Chlorinated?: .yes_____ 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) 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#:.
(cirele tests) C •
1. Color 20. Acidity 39. Aluminum - 59. Potassium wt,” t
2. T urbidity 21. Alkalinity, as CaCOs 40. Antimony 60. Selenium . . t
3. pH 22. Bromide 41. Arsenic 61. Silver
4. Conductivity 23. Bromate/Chlorate/Chlorite 42. Barium 62. Sodium
63. Thallium
(i01
5. Corrosivity (temp: °C) 24. Chloride 43. Beryllium
6. 25. Cyanide 44. Boron 64. Vanadium i
7. Sduble BOD (5 day) 26. Fluoride 45. Cadmium 65. Zinc ’
8. Carbonaceous BOD (5 day) 27. Hardness, Total as CaCOa 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-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
Uplids, 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:_____________ 38. UV254 57. Molybdenum 75. TCLP-BNA’s
58. Nickel
NYC-WTC_000026869
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