Environmental services sample submission form, Westchester County Lab

NYC 9/11 Public Portal Document

in UlertchMWr County

Time/Date Set:____________________________ _ ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road. Valhalla, New York 10595 /»/ £*/ (914) 593-5575 L-tM « / » 4'11 NYS-ELAP No. 10108

RoTTit I JOI I te M CI 4-”^. |c^ oojutT Sample Type (circle one); (iOT f 14. O 2 ele, ST?, 2/*, ^~~Potabi^ 3. Non-Potable Treated Bottle #’s:OC»SLt», 2^/ 2. Non-Potable 4. Other__________________ ----- Chain of Custody?yes nog. j Kt f k T1 ‘ 2.^ Time/Date Collected: 11 Comments: Collected By:^T•^<i>n Aoencv Code: PWS #:_______ Source ID: Type Descriptor:. Collected From: Bill to: Location's/lndividual’s Name M C ~ Of P _ Name/Company Street I W areet City/SVZip_ iMXlICt I t°C*)C xity/st/Zip. Identification of Source ________________ _ Phone#:, _Fax Collection Point— ----- -T-rrr ~^r--------- CrW C liil—1 cX, CH, Bl? Check#: Amounts.

BACTERIOLOGICAL ANALYSES ORGANIC ^A^E^AL^ES ORGANIC NONPOTABLE/SOLID ANALYSES Lab#:_______ ______________ (circle tests) (Circle tests) k 1. Heterotrophic Plate Trihalomethanes (524) / 1. Purgeable Halocarbons (624/8260) Count (hemodialysis & all others) Volatile Halocarbons (524) > 2. Purgeable Aromatics (624/8260) , 2. CoMorm P/A (public supplies) 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) 5..zMicroextractables (504) 5. Organochlorine Pesticides (608/8080) 5. Microscopic e^Pesticides (507) 6. PCB’s (Arochlors) (608/8080) 6. Macroscopic T^esticides/PCB screen (508) 7. Herbicides (SM-18/6640; 8151) 7. ap: K PCB as Decachlorobiphenyl (508A) 8. Other Pesticides (SM-18/6630) / 8. Other:_________________ __ ^Herbicides (515) 9. Petroleum Hydrocarbon Scan (310-13) , 1Q< ’esticides (525) 10. Glycols in Water Refrigerated? .yes. .no Darbamate Pesticides (531) 11. Acid Extractables (625/8270) Slyphosate (547) 12. Base Neutral Extractables (625/8270) Chlorinated?: .yes. no ( J^/Diquat (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) f Total Chlorine Res: .mg/L 17. Petroleum/Hydrocarbon Scan (310-13) 17. PCB's (Arochlors) (DEF) - £H V "S INORGANIC ANALYSES REQUESTED - Lab#:. (circle tests) 1. Color 20. Acidity Alunwum Potassbm 2. Turbidity 21. Alkalinity, as CaCOa 40. Antimony 60. Selenii^m 3. pH 22. Bromide 41. Arsenifc 61. Silver • 4. Conductivity **53. Bromate/Chlorate/Chlorite 42. Barium 62. Sodium 5. Corrosivity (temp: .•C) 24. Chloride .43. Beryllium 63. Thallium 6. BOD (5 day) 25. Cyanide 44; Boron 64. Vanadium 7. Soluble BOD (5 day) 26. Fluoride. ^[^Cadmium ^SyZinc 8. Carbonaceous BOO (5 day) 27. Hardness, Total as CaCOa 46. Calcium, as CaCOa CLP 9. Chemical Oxygen Demand 28. Nitrogen, Ammonia as N /^Calcium, Ca*’ 66. Metals/CN 10. Dissolved Oxygen 29. Nitrogen, Nitrate as N Chromium, Total 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 Cobalt 69. Pesticides/PCB’s 13. Solids, Percent (%) 32. Oil and Grease 51 Copper 70. Disk Deliverables 14. Solids. Settleable 33 Phenol 52 Iron letp 15. Solids. Suspended 34. Phosphorus. Total as P 53. Lead 71. TCLP-Metals 16. Solids. Total 35. Phosphorus, Ortho as P 54I. Magnesium 72. TCLP-Pesticides 17. Solids. Total Dissolved 36. Sulfates 55i. Manganese 73. TCLP-Herbicides 18 Solids. Total Volatile 37. Surfactants 56.i. Mercury 74. TCLP-Volatiles 19. Other: 38. UV254 57. Molybdenum 75. TCLP-BNA's tgej Nickel

NYC-WTC_000063140