Environmental services sample submission form, Westchester County Lab

NYC 9/11 Public Portal Document

e lU ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 (Uestshastar County (914)593-5575 NY^ELAP No. 1010 Time/Date Set: . n.Ui, ?■.?< fl J. ■’//. 7;'. /Vt.-. rA' Sample Type (circle one): 72’-'/.i’*.? St . i-f i.lti <•'<•'-1- ji( (^Potable 3. Non-Potable Treated Bottle __________ 2. Non-Potable 4. Other Chain of Custody? Y®s no Time/Date Collected:. Comments: Collected By/ f Aoencv Code: . PWS #;__________ __ Source ID;. Type Descriptor:. Collected From; ’ Bill to: Location's/lndividuars Name^^"?^ - ____________ Name/Company Street 1^ kJ? i U Lf V.z Street ______ City/St/ZiD V4{KAiU bJ.V. < 0^ n / ) i y " ' City/St/Zip Identification of Source __________ p)yn^:| / '_Fax*: Collection Point, CK/J 6 | c/^ C^, ^-et?. Check#:, Amounts. ORGANIC POTABlCaNALYSES BACTERIOLOGICAL ANALYSES ORGANIC NONPOTABLE/SOLIO ANALYSES Lab#:_________ _ (circle tests) Idrcte tests) / 1. Heterotrophic Plate Trihalometlylfles (524) ’ ' I 1. Purgeable Halocarbons (62478260) Count (hemodialysis & all others) Volatile Halocarbons (524) 2. Purgeable Aromatics (624/8260) 2. Coliform P/A (public supplies) E®] Volatile Aromatics (524) 3. Acrolein & Acrylonitrile (624) 3. Coliform MPN (priv well, raw, stp) Total Trihalomethane Potential (510) 4. Phthalates (606/8060) 4. Fecal Coliform (all samples) Microextractables (504) 5. Organochlorine Pesticides (608/8080) 5. Microscopic Pesticides (507) 6. PCB's (Arochlors) (608/8080) 6. Macroscopic Pesticides/PCB screen (508) 7. Herbicides (SM-18/6640; 8151) 7. API ■8/ PCB as Decachlorobiphenyl (508A) 8. Other Pesticides (SM-18/6630) 8. Other:______ ______ . ' - , ' Herbicides (515) 9. Petroleum Hydrocarbon Scan (310-13) Pesticides (525) 10. Glycols in Water Refrigerated? .yes no ^Carbamate Pesticides (531) 11. Acid Extractables (625/8270) T^^lyphosate (547) - 12. Base Neutral Extractables (625/8270) Chtonnated?: .yes no ^j^^iquat (549) 13. GC/MS Unknown Scan 14. Chlorination Disinfection Byproducts (551) 14. Purgeable Halocarbons (DEF) Free Chlorine 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)

pH.

INORGANIC ANALYSES REQUESTED - Lab«: (circle tests) 1. Color 20. Acidity y 3^. Aluminum 59?'Potassium 2. Turbidity 3. pH 21. Alkalinity, as CaCO^ 22. Bromide r I 4^ Antimony 411 Arsenic 51 eO.Seleqium 61 (Silver 4. Conductivity 23. Bromate/Chlorate/Chlorite 42.1 Barium 62. Sodium 5. Corrosivity (temp: “C) 24. Chloride 43^ Beryllium 63 Thallium 6. BOD (5 day) 25. Cyanide Boron 64 Vanadium 7. Soluble BOD (5 day) 26. Fluoride Cadmium 6^ Zinc. .J A t 8. Carbonaceous BOD (5 day) 27. Hardness, Total as CaCOa 46. Calcium, as CaCOj ^^P 9. Chemical Oxygen Demand 28. Nitrogen, Ammonia as N r^T^alcium, Ca*^ 66. Metals/CN 10. Dissolved Oxygen 29. Nitrogen, Nitrate as N Q^4^^hromium, Total 67. Volatiles 11, Total Organic Carbon 30. Nitrogen, Nitrite as N 4^ Chromium, Hexavalent 68. Semi-volatiles 12. Total Organic Halides 31. Nitrogen, Total Kjeldahl as N /^Cobalt 69. Pestictdes/PCB's 13. Solids. Percent (%) 32. Oil and Grease 51.1 Copper 70. Disk Deliverables 14. Solids, Settleable 33. Phenol 52.Uron TCLP 15. Solids. Suspended 34. Phosphorus; Total as P 53. Lead 71. TCLP-Metals 16. Solids, Total 35. Phosphorus, Ortho as P 54.lMagnesium 72. TCLP-Pesticides 17. Solids, Total Dissolved 36. Sulfates 55. Manganese 73. TCLP-Herbicides 18. Solids. Total Volatile 37. Surtactants 56. Mercury 74. TCLP-Volatiles 19. Other:' 38. UV254 57./Molybdenum 75. TCLP-BNA's \ sy Nickel

NYC-WTC_000063023