NYC 9/11 Public Portal Document
ENVIRONMENTAL SERVICES SAWPLE SUBMISSCN FORM
III
lestchester(ountya
WESTCHLSTER COUNTY LABSRATOHIS AND Nor ARCH
0201am/12DanaRoad,Valhalla,NewYork10595PmMT
/(914 593-5575 MV L- Ai’ N .
Form A-70 (rev. y
Time/Date Set:__________________
Sample Type (circle one): *G ) ***37 1 08 - ■ S** A . nn 5
31.P-S66T7./eA=*-717
1. Potable)—3. Non-Potable Treated Bottle #‘s: "TArAAAmmcsooobccucosebccoALcLcsnasE
2.Non-Potable-4.Other Chain of Custody? - yes_____ no
Time/Date Collected:_ //_ -2
■ — Comments:
Collected _ ________________________ Agency Code:..,,.. PWS #__________ Source ID:_______ Type Descriptor:____
Collected
*GeRSGssmmFrom
EEe_sAsnd
Location’s/Individual’s Name__ N V C__ ___________
Bill to D
Name/Company___
______________________________ ___ . . Street i
Citv/St/ZipVALHALLA At i City/St/Zip________
Identification of Source_____ "Phone# I _ Fax#
■ Collection Point (So .GH I CA,CH. BI? - _ . Check# N Amou nt $
UAc !: 504 <X Ar ANALYSTS ORGANIC 1*3 Mil / A?i r- - ct? 7.K NONPOAsit 3 50.0) ANALYSt 3
Lab #
(circle tests) rdGecd
LabInl
| (circle tests)
m
1. Heterotrophic Plate 1. Trihalomethanes (524) 1. Purgeable Halocarbons (624/8260)
Count (hemodialysis & all others) <2A Volatile Halocarbons (524) 2. Purgeable Aromatics (624/8260)
2. Coliform P/A (public supplies) 3,4 Volatile Aromatics (524) 3. Acrolein & Acrylonitrile (624)
3. Coliform 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) ’ .
5.6. Microscopic
Macroscopic --------
-------- 6. ■ Pesticides (507)
' 7) Pesticides/PCB screen (508)
6. PCB's (Arochlors) (608/8080) ■
i. Herbicides (SM-18/6640; 8151).
7ARI-
8.Oer 8.PCB as Decachlorobiphenyl (508A)
94 Herbicides (515)
8. Other Pesticides (SM-18/6630)
i '■ doumilvatsathen an (C 13)
10) Pesticides (525) 10. Glycols in Water
Refricerated? yes no Hi. Carbamate Pesticides (531) 11. Acid Extractables (625/8270)
12. Glyphosate (547) 12. Base Neutral Extractables (625/8270)
Chionnated?:____ ..yes______ no ' 13. Diquat (549) 13. GC/MS Unknown Scan
14. Chlorination Disinfection Byproducts (551) 14. Purgeable Halocarbons (DEF)
f ree Chlorine Hes:. mo/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)
H
•■ ai i an Ai. ? m St: cm sn o L. i -
(o
I
ircle tests) .
.20. Acidity
I
59. Potassium i l
Ul
Turbidity — 21. Alkalinity, as CaCO3 ■■
39.. Aluminum
40. Antimony 1 60. Selenium ( /
13 IpH 22. Bromide 41. Arsenic I 61. Silver ' ■ '
4 Conductivity 23. Bromate/Chlorate/Chiorite 42.. Barium 62. Sodium !
5 Corrosivity (temp: _____ °C) 24. Chloride . 43. Beryllium ' 63. Thallium
6 BOD (5 day)
7 Soluble BOD (5 day)
25. Cyanide
26. Fluoride
44. Boron
45. Cadmium
(64. Vanadium .
65. Zinc _ __ :___
8 Carbonaceous BOD (5 day) 27. Hardness, Total as CaCOa 46. Calcium, as CaCOa CLP
(9 Chemical Oxygen Demand
,10. Dissolved Oxygen
28. Nitrogen; Ammonia as N
29. Nitrogen, Nitrate as N
47. Calcium, Ca*2
48. Chromium, Total
66. Metals/CN
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 (%)
14. Solids, Settleable
32. 011 and Grease
33. Phenol
51.Copper
52. Iron
70. Disk Deliverables
TCLP
15. Solids, Suspended
16. Sciids, Total
34. Phosphorus. Total as P
35. Phosphorus, Ortho as P
53. Lead a 71. TCLP-Metals
54, Magnesium 72. TCLP-Pesticides
1 7. Solids, Total Dissolved
,18. Solids, Total Volatile
36. Sulfates
37.Surfactants.A 55. Manganese 73. TCLP-Herbicides
11QOhArSaer 38.UV254m 57Moly
71. "* 0 V! tes
/ TCI P NA‘s
. •: is '■!
NYC-WTC_000027168
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