NYC 9/11 Public Portal Document
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ENVIRONMENTAL SERVICFS SAMPLE SUBMISSION FOFM
WESTCHESTER COUN1Y LAB nicetn AM: REGLARCH • r?
Uestchester County
Valhal a, New York
912 Dana Road,9145935575 mm 10595" NYS-ELAP No. 1 ,
Time/Date Set: ■ 74 (rev.
Form.A-70 s. 2 1/96, _
■ 21)4 GlAASAAmn
zupptolyor
1. Potable,
19)
3. Noh-Potable Treated
C.Al(0
Bottle #‘s:_ ■
5—
2. Non-Potable 4. Other a 9
Chain of Custody9_____ yes_____ no
Time/Date Collected:_________ Comments: ____________________
Collected By:_= __ ___ 2 _ _____ Agency Code:___ May ______ Source D:_______ Type Descriptor:__
Collected From
L.ocation’s/Individual’s Name
*=a),ogg. Bill to:
N a me.C ompa ny___
Street___________ ___ ■ Street
City/StZip__________ City/StZip
Identification of Source Phone#: _ Fax #:
L Collection Point___ I CA,CH. Check#:,. Amounts
BACTERIOLOGICAL ANALYSES ORGANIC 1 Aok i A? Pi y‘ 13 AC NONPO! Afi? , ‘(: ANALYSF$
Lab *
(circle lests, -
Lab#_
(circle tests) m
1. Heterotrophic Plate 1 Trhalomethanes (524) 1. Purgeable Halocarbons (624/8260)
Count (hemodialysis & all others) 2 Volatile Halocarbons (524) 2. Purgeable Aromatics (624/8260)
2 CoMorm P/A (public supplies) i 3. Volatile Aromatics (524) 3. Acrolein & Acrylonitrile (624)
3 Coliform MPN (priv well, raw, stp) 4.4 Total Tnhalomethane Potential (510) 4. Phthalates (606/8060)
5.1
4. Feral Coliform (all samples)
5. Microscopic—
6. Macroscopic "e $ Pesticides (507)-—
Microextractables (504)
Pesticides/PCB screen (508)
5. Organochlorine Pesticides (608/8080)
6. PCB's (Arochlors) (608/8080)
7. Herbicides (SM-18/6640; 8151)
7AP//////000 8_ PCB as Decachlorobiphenyl (508A) 8. Other Pesticides (SM-18/6630)
8. Other . 9.Herbicides (515)
(0. Pesticides (525)
9. Petroleum Hydrocarbon Scan (310-13)
10. Glycols in Water
Refrigerated? yes_____ no 1 1Garbamate Pesticides (531) 11. Acid Extractables (625/8270)
12. Glyphosate (547) 12. Base Neutral Extractables (625/8270)
Chlorinated9:____ 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 _
' ■.' • * ■ ASA i >: •: S Hi-Ct IS * t D
N(circle tests) aud
; •
C/. ye
W, color 20. Acidity 39. Aluminum 59. Potassium
112. Turbidity "
"3_oHs 21. Alkalinity, as C3CO3
22. Bromide
40. Antimony
41. Arsenic 1102
60. Selenium
61. Silver
4. Conductivity 23. Bromate/ChlorateChiorite 42. Barium 207 62. Sodium
I 5 Corrosivity (temp: ______°C) 24..Chloride 243. Beryllium a • 63. Thallium
I 6.
I 7.
BOD (5 day)
Soluble BOD (5 day)
25. Cyanide 44. Boron . " 64„.Vanadium
26. Fluoride 45. Cadmium " 65. Zinc______ ____
(8. Carbonaceous BOD (5 day) 27. Hardness, Total as CaCO3 46. Calcium, as CaCOa CLP
9; Chemical Oxygen Demand 28. Nitrogen, Ammonia as N 47. Calcium. Ca" 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 2* ef" lili-’;
12. Total Organic Halides 31.Nton, olkjelst * 50. Cobalt ovi ! P-trepiout is
13. Solids, Percent (%)
32. 011 and Grease ) 51.Copper / Dk i l-liveish’e,
ITCLP_
— 52.ron
14. Sobds, Settleable 33. Phenol
L 15. Solids. Suspended
j 16. Sc lids. Total
i 53, Lead
34. Phosphorus. Total as P 71. TCLP-Metals
35. Phosphorus, Ortho as P 54. Magnesium 72. TCLP-Pesticides
Other Total
-18.Solids. Volatile 37, Surfactants _ 457.
। 17. Solids, Total Dissolved 36. Sulfates 55. Manganese 73. TCLP-Herbicides
56. Mercury
19 SeT,msa 38.UV254=eeC Molybdenum e . 74. TCLP-Volatiles
■ 75. TCLP-BNA's
— 58. Nickel lcdesas
NYC-WTC_000027063
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