NYC 9/11 Public Portal Document
III
ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM
WEST CHES TR COUNTY L ABCRATORIS ANP RESMARCH
2 Dana Road, Valhalla, New York 10595
Uestchester County
914 593-5575 G NYS-ELAP No. 10108
ane/Date Set: Form A-70 (rev. 1/96)
Sample Type (circle one): oAldb.AFB22E6039,k6266m
1Potable 3. Non-Potable Treated Bottle * ‘s± N-20 76 25 T __ _____________
2. Non-Potable 4. Other. Chain of Custody? _ __yes__ Ino K‘781 87oli b t.
Time/Date Collected: 20O D-9l__ Comments:... ___________________ __
Collected By_2.2 » FT Acency Code:___ PWS #: Source ID' Type Descriptor:
Collected From: .. i ■
****// T
L oc a t i o n ’ s /1 n d iv id u a'' s N a me_ L L Name/Company, _
Street_ __s __ ___ L Street___
City/StZip. / /s NY City/StZip
identification of Source . Phone# Fax #
Collection Point t / f | CA, CH, Bl? Check#: Amount?
A f- i "Bit As ANALY6 5 OReANK Pt ‘ Aii l AN*) Yi : (44.4 talr Nt »NP( H A;;| « )i.i[) ANALY3.S
I Lab#:mntl
(circle tests)
LabIe
((circle lests)
s
1. Heterotrophic Plate 1„ Trihalomethanes (524) 1. Purgeable Halocarbons (624/8260)
Count (hemodialysis & all others) ?2.i Volatile Halocarbons (524) 2. Purgeable Aromatics (624/8260) .
? CoMorm P/A (public supplies) 13/ Volatile Aromatics (524) 3. Acrolein & Acrylonitrile (624) . :
| 3 Coliform MPN (prv well, raw, stp) 4. I otai Trihalomethane Potential (510) 4. Phthalates (606/8060)
4. Fecal Coliform (ail samples) 5. Microextractables (504) . 5. Organochlorine Pesticides (608/8080) /
5. Microscopic 6, Pesticides (507) 46: PCB's (Arochlors) (608/8080) :
6. Macroscopic (7) Pesticides/PCB screen (508) 7. Herbicides (SM-18/6640; 8151)
7 API 8. PCB as Decachlorobiphenyl (508A) 8. Other Pesticides (SM-18/6630)
ae "
Refrigerated?_____ yes........ no
9. Herbicides (515)
(10. Pesticides (525)
11. Carbamate Pesticides (531)
—10. Glycols in Water =
9. Petroleum Hydrocarbon Scan (310-13)
.11. Acid Extractables (625/8270) i
! Chlonnated”: _ yes_____ no _ _ w_.. CSE.GQ/MS Unknown Scan s
12. Glyphosate (547)
13. Diquat (549)
14. Chlorination Disinfection Byproducts (551)
_ 12 Base Neutral Extractables (625/8270) ':
14. Purgeable Halocarbons (DEF)
F roe Chionne 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)
■
•* ■ ? *‘. **A Yi 5 Hl i -Ur *!t it .
(circle tests) MW
J . 39. Aluminum
.—COOpCeee 20. Acidity 59. Potassium
I 2. Turbidity 22.
21. Alkalinity, as CaCO3 (.40? Antimony 60. Selenium?
3HE Bromide 4 1. Arsenic 61. Silver I
4. Conductivity
5. Corrosivity (temp:____ _OC)
23. Bromate/Chlorate/Chlorite
24. Chloride . 42. Barium_
(43.)Beryllum9 62. Sodium ’
(63Thallium 1
I
6. HOD (5 day) 25.Cyandet 44. Boron r (64. Vanadium 55
7 Soluble BOD (5 day) i 26.Fluondee9 46.Calcium,asCaCOa 45. Cadmium 65. Zinc
CLP_L
ft. Carbonacecus BOD (5 day)
9. Chemical Oxygen Demand
27. Hardness, Total as CaCOa
Nitrate
28. Nitrogen, Ammonia as N
29. Nitrogen, as N 47.48.CChromi ”?
alcium,um,CaTotal e 67.68.Semi-volatiles
Volatiles "
66. Metals/CN
10. Dissolved Oxygen
30. Nitrogen, Nitrite as N 149. Chromium, Hexavalent
Cobalt smass
" 650
11. Total Organic Carbon
12. Total Organic Halides
13. Solids, Percent (%) and Grease
32.33.P011henol
31. Nitrogen, Total Kjeldahl as N
51. Copper M
52. Iron 10107
69. Pesticides/PCB’s
70. Disk Deliverables
TCLPde
se
1 34. Phosphorus. Ortho
Total asasP "53.Lead"Ppe 71.TCLP-Metals
16. Sol i d s, Tot a l —msp 35.Phosphorus.
117.Solids, Total Dissolved an 36,Sulfates ■ P. 54. Magnesium
“55. Manganese e
72. TCL P-Pesticides
118. Sol
(9oter“Tii ds. Total Vol a t i le ann 37. Surfactants
38UV254
“(5756., Mercury eee
Molybdenum _ $74.TCLP-Volatiles
73. TCLP-Herbicides
/b T< ! I’ NNA"
158. Nickel tet
NYC-WTC_000027249
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