Environmental services sample submission form, Westchester County Lab

NYC 9/11 Public Portal Document

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM >vcom WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 pi (914)593-5575 ' - i 1^*7, I ' tlVS-ELAPNo. 10108 Time/Date Set: __ ______ r3~U 273, J7S, i3/ Sample Type (circle one): A. Potable 3. Non Potable Treated Bottfe #'s‘ '^Non Potable 4. Other ____________ < i_________ Chain of Custody? yes no Time/Date Collected: ip iS" ?/ H Comments: Collected By:'C-tx* <4-Q Agency Code: PWS#: Source ID: .Type Descriptor: Collected From: to: Location's/lndividuars Name Ai/C Q£?. Name/Company Street ____ ,__ .----------- Street_______ City/St/Zip U-k Ua /t/ City/St/Zip Identification of Source . ____________ Phone#: Fax#: Collection Point. dal Lrpft CA.CH. Bl? Cheddf: Amounts.

BACTERIOLOGICAL ANALYSIS ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABUE/SOUD ANALYSIS Lab#:__________ . Lab#: .. Z) Zl I I (circle tests) J^rcle tests) I kK / 1. Heterotrophic Plate Q Trihalomethanes (524) 1. Purgeable Halocarbons (624/8260) Count (hemodialysis & all others) Volatile Halocarbons (524) 2. Purgeable Aromatics (624/8260) 2. Coliform P/A (public supplies) Volatile Aromatics (524) 3. Acrolein & Acrylonitrile (624) 3. Coliform MPN (priv well, raw, stp) 4. Total Trihalomethane Potential (510) 4. Phthalates (625/8270) j4. Fecal Coliform (all samples) Microextractables (504) 5. Organochlorine Pesticides (608/8081) E. Microscopic V Pesticides (507) 6. PCB’s (Arochlors) (608/8081) ' B. Macroscopic Pesticides/PCB screen (508) 7. Methoprene (616) < 7. API 8, PCB as Decachlorobiphenyl (508A) 8. Herbicides (EPAI 978/8151) 8. Other;_________ __________ 0 Herbicides (515) 9. Pesticides (SMI 8/6630) ^ Pesticides (525) 10. Petroleum Hydrocarbon Scan (310-13) iRefrigerated? yes no 'TO Carbamate Pesticides (531) 11. Glycols Ehlorinated:? yes no /W Glyphosate (547) 12. Acid Extractables (625/8270) n^Diquat (549) 13. Base Neutral Extractables (625/8270) 1!ree Chlorine Res:. mg/L 14; Chlorination Disinfection Byproducts (551) 14. GC/MS Semivolatile Unkriown Scan ital Chlorine Res: mg/L 15. Haloacetic Acids (552) 15. Purgeable Halocarbons (DEF) i 16. Pesticides (SM18/6630) 16. Purgeable Aromatics (DEF) 17. Petroleum/Hydrocarbon Scan (310-13) 17. Pesticides/PCB's (DEF) ■ (5^Other: SVtj -i* 18. Other;________________________

[NORGANiC ANALYSIS REQUESTED - Lab#: (circle tests) 1. Color 20. Acidity p9^Aluminum 59. j Potassium 2. Turbidity 21. Alkalinity, as CaCOs I 40.|Antimony . 60.'selenium 3. pH 22. Bromide I 41. Arsenic w V 61.'silver 4. Conductivity 23. Bromate/Chlorate/Chlorite \42. Barium J 62. Sodium 5. Corrosivity (temp: .®C) 24. Chloride flsjberyllium 63. Thallium 6. BOD (5 day) • 25. Cyanide 44. Boron ■ 64.1 Vanadium 7. Soluble BOD (5 day) 26. Fluoride (^^admium \6^ Zinc 8. Carbonaceous BOD (5 day) 27. Hardness, Total as CaCOs 46. Calcium, as CaCOa ISE 9. Chemical Oxygen Demand 28. Nitrogen, Ammonia as N Calcium, Ca 66. Metals/CN 10. Dissolved Oxygen 29. Nitrogen, Nitrate as N :hromium. 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 -SO^obalt 69. Pesticides/PCB's 13. Solids, Percent (%) 32. Oil an Grease ^^opper 70. Disk Deliverables 14. Solids, Settleable 33. Phenol 15, Solids, Suspended 34. Phosphorus Total as P "gsXead IGLP 71 .TCLP-Metals 16. Solids, Total 35. Phosphorus, Ortho as P Magnesium 72.TCLP-Pesticides 17. Solids, Total Dissolved 36. Sulfates '5. \j1anganese 73.TCLP-Herbicides 18. Solids, Total Volatile 19. Other_________________ 37. Surfactants 38. UV254 1Mercury Molybdenum (^^/Nickel 74. TCLP-Volatiles 75.TCLP-BNA’s

NYC-WTC_000063019