NYC 9/11 Public Portal Document
09
ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM
ster
iv.com WESTCHESTER COUNTY LABORATORIES AND RESEARCH
2 Dana Road, Valhalla, New York 10595
(914) 593-5575
(/Date Set: NYS-ELAP No. 10108
Form A-70 (rev.1/96)
Sample Type (circle one):
66447. 6924 696.0267 s3/
(1. Potable 3. Non Potable Treated . „7825,
Bottle *Si C 973 98-::42667272 9964
-- ---------------------------------------
2. Non Potable 4. Other- Chain of Custody? yes no
Time/Date Collected: /o-o 9-0 / 08/0 Comments:
Collected By: C’ Agency Code: _ Source ID: Type Descriptor
Collected From: Bill to:
Location's/dividual's Name _ QA Name/Company _
Street_________________________ Street________
City/St/Zip ______ _______________ City/St/Zip_____
Identification of Source' -__________ DeP* Phone#:______ Fax#:
Collection Point 4- /.SQ .30734 CA,CH, Bl? Check#: Amounts.
BACTERIOLOGICAL ANALYSIS ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLID ANALYSIS
Lab#:____________________ Lab#:
(circle tests)
))11 /
/ U 1^1
(circle tests)
1. Heterotrophic Plate 1 Trihalomethanes (524) > 1. Purgeable Halocarbons (624/8260)
Count (hemodialysis & all others) /2. Volatile Halocarbons (524) 2. Purgeable Aromatics (624/8260)
2. Coliform P/A (public supplies) 3/ Volatile Aromatics (524) 3. Acrolein & Acrylonitrile (624) 2
3. Coliform MPN (priv well, raw, stp) 4. Total Trihalomethane Potential (510) 4. Phthalates (625/8270)
4. Fecal Coliform (all samples) 5. Microextractables (504) 5. Organochlorine Pesticides (608/8081)
5. Microscopic 6, Pesticides (507) 6. PCB’s (Arochlors) (608/8081)
Scroscopig 2 Pesticides/PCB screen (508) 7. Methoprene (616) 4
8. PCB as Decachlorobiphenyl (508A) 8. Herbicides (EPA1978/8151)
8. Other__________________ 9. Herbicides (515) . 9. Pesticides (SM18/6630)
(0 Pesticides (525) 10. Petroleum Hydrocarbon Scan (310-13)
Refrigerated? yes no 11. Carbamate Pesticides (531) 11. Glycols
Chlorinated:? yes no 12. Glyphosate (547) 12. Acid Extractables (625/8270)
13. Diquat (549) 13. Base Neutral Extractables (625/8270)
Free Chlorine Res:. mg/L 14. Chlorination Disinfection Byproducts (551) (4.GC/MS Semivolatile Unknown Scan
15. Haloacetic Acids (552) 15. Purgeable Halocarbons (DEF)
Total Chlorine Res: mg/L
16. Pesticides (SM18/6630) 16. Purgeable Aromatics (DEF)
pH 17. Petroleum/Hydrocarbon Scan (310-13) 17. Pesticides/PCB's (DEF)
18. Other_______________________ 18. Other t
INORGANIC ANALYSIS REQUESTED - Lab#:
(circle tests)
1. Color 20. Acidity
21. Alkalinity, as CaCO3
39. Aluminum
40. Antimony
=Moak 59. Potassium
60. Selenium / >
—
2. Turbidity
3. pH 22. Bromide 41. Arsenic 61. Silver; /
4. Conductivity 23. Bromate/Chlorate/Chlorite 42. Barium 62. Sodium
5. Corrosivity (temp: °C) 24. Chloride 43. Beryllium
44. Boron
63. Thallium
6. BOD (5 day) 25. Cyanide 64. Vanadium
7. Soluble BOD (5 day) 26. Fluoride 45. Cadmium 65. Zinc
8. Carbonaceous BOD (5 day) 27. Hardness, Total as CaCO3 46. Calcium, as CaCOs CLP
9. Chemical Oxygen Demand 28. Nitrogen, Ammonia as N 47.Calclum, 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-violatiles
12. Total Organic Halides 31. Nitrogen, Total Kjeldahl as N 50.Cobalt 69. Pesticides/PCB’s
13 Solids, Percent (%) 32. Oil an Grease 51. Copper 70. Disk Deliverables
(Solids, Settleable 33. Phenol 52. Iron
53.Lead TCLP
15. Solids, Suspended 34. Phosphorus Total as P
54 Magnesium 71 .TCLP-Metals
16. Solids, Total 35. Phosphorus, Ortho as P
36. Sulfates 55 Manganese 72.TCLP-Pesticides
17. Solids, Total Dissolved 73.TCLP-Herbicides
18. Solids, Total Volatile 37. Surfactants 56. Mercury
38. UV254 57 Molybdenum 74. TCLP-Volatiles
19. Other________________ 75.TCLP-BNAs
58. Nickel
sutesats . ■. ■ .■ hass 44 t
NYC-WTC_000027643
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