NYC 9/11 Public Portal Document
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ENVIRONMENTAL SERVICES SAMPLE SueMss:oN FORM
WL ST CHEST EH COUNTY ! AUORA,ORif S AND HF. "I Alci
1 ---2 Dana Road, Valhal a, New York 10595
--5991914)593-5575—0014)
Time/Date Set:__ _ ______________ _________
" NYS-ELAPNo.
P
1
Form A-70(rev:1/u) —
Sample Type (circle one) - A
10/1,22// 7 24
1. Potable' 3. Non-Potable Treated ■ Bottle #‘s:_ _
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Jluaee La
2. Non-Potable 4. Other______________
Time/Date Collected:______ :
Chain of Custody?_
Comments:
XyesiE . ' 2 4. . 4.
no
Az
Collected By:_ _______ __ _ ____ Agency Code: PWS #:_________ Source ID:; _Type Descriptor:
Collected From: Bill to
Location‘s/ndividual‘s Name ts Name/Company
Street___ —i ? id — Street
City/St/Zip 7 .a 1. City/StZip_______
Identification of Source Phone#:____ ____ . -... Fax#
| CA, CH. Bi? Check#: Amounts
Collection Point _
nAt H Hjet AL ANALYSES SGANKC POiAW ‘ ANAL K i. * Ci-UANaC NONBAli.i /sittjn ANALYSS
Lab* Lab #
1 ((circle tests) Eee
(circle tests)
1. Heterotrophic Plate 1. Trihalomethanes (524) 1. Purgeable Halocarbons (624/8260)
Count (hemodialysis & all others) 4 2 Volatile Halocarbons (524) 2. Purgeable'Aromatics (624/8260)
2.Conform P/A (public supplies) (3 Volatile Aromatics (524) 3. Acrolein & Acrylonitrile (624)
3. Coliform MPN (prv 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)
5. Microscopic 6.r Pesticides (507) 6. PCB's (Arochlors) (608/8080)
(7 Pesticides/PCB screen (508)
7ARL
6. Macroscopic
8. Other:
8, PCB as Decachlorobiphenyl (508A)
9« Herbicides (515)
7. Herbicides (SM-18/6640; 8151)
8. Other Pesticides (SM-18/6630)
9. Petroleum Hydrocarbon Scan (310-13)
.
( fo Pesticides (525) 10. Glycols in .Water
Refrigerated? ....___ yes_____ no 11.Carbamate Pesticides (531) 1 1. Acid Extractables (625/8270)
12. Glyphosate (547) 12. Base Neutral Extractables (625/8270)
Chionnated?: yes r. • 13. Diquat (549) 13. GC/MS Unknown Scan
14. Chlorination Disinfection Byproducts (551) 14. Purgeable Halocarbons (DEF)
Free Chtonne Res: ___mg/L 15. Haioacetic Acids (552) 15. Purgeable Aromatics (DEF)
16. Other Pesticides (SM-18/6630) 16 Pesticides (DEF)
Total Ch’orine Res: . mg/L 17. Petroleum/Hydrocarbon Scan (310-13) 1 7. PCB's (Arochlors) (DEF)
LJ___
J
0* va ’ Avi v s ntsn p i i :
(circle tests)
)77 wil
1.2 Color
Turbidity
ooe 20. Acidity 39. Aluminum 59. Potassium
21. Alkalinity, as CaCO3 .40.- Antimony 60. Selenium
3p H 22. Bromide 41."Arsenic 61. Silver
4. Conductivity 23. B-omate/Chlorate/Chlorite 42. Barium 62. Sodium
5 Corrosivity (temp: _ ■ :•
24. Chloride NR .43. Beryllium . 63. Thallium
iukeckor
6.
7.
(8.
' 9.
ROD (5 day)
Soluble BOD (5 day)
Carbonaceous BOD (5 day)
Chemical Oxygen Demand
25. Cyanide
26. Fluoride ■
27. Hardness, Total as CaCO3
28. Nitrogen, Ammonia as N
' 44; Boron
, 45. Cadmium
:46. Calcium, as CaCO3
47. Calcium, Ca'2
,64. Vanadium
' 65. Zinc___ _____
CLPmeppne
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-volatiies
12. Totai Organic Halides 31. N trogen. Total Kjeldahl as N 50. Cobalt 69. Pesticides/PCB’s
51. Copper ee 70. Disk Deliverables
13. Solids, Percent (%)
14. Solds. Settleable
32. Oil and Grease
33, Phenol 52.Ironp.pe) TCLP
15 Solids, Suspended
16. Sclids, Total
34. Phosphorus. Total as P
35. Phosphorus, Ortho as P
53.Leadyemeni
54. Magnesium
71. TCLP-Metals
1 72. TCLP-Pesticides
.18. Solids Total Volatile ) 37. Surfactants --
2 . 17. Solids, Total Dissolved 36. Sulfates 55. Manganese sn 73. TCLP-Herbicides
56. Mercury . 74. TCLP-Volatiles
19, OtherC.a 38.UV254 57. Molybdenum Ask
l- 58. Nickel - '
' 75. TCLP-BNA's
NYC-WTC_000027064
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