Environmental services sample submission form, Westchester County Lab

NYC 9/11 Public Portal Document

HI ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road. Valhalla, New York 10595 fto iU C UiattchMiw County (914)593-5575 1^6 ( 'Y U, NYS-ELAP No. 10108 Time/Date Set:_________ Form A-70 (rev. 1/96) Sample Type (circle one): m f 41'JOS ? 10# .'I'l Jl^otab^ 3. Non-Potable Treated Bottle#*8:'H»it,6QLt 044s . lit u',. 2. Non-Potable 4. Other_____________ Chain of Custody? .yes no Time/Date Collected: K «> • Comments:^__ Collected By: Agency Code: PWS Source ID:. Type Descriptor: Collected From: Bill to: Location’s/lndividual's Name. Ms'5 - g p Name/Company Street ( < I Ia ( Street_________ City/St/Zio Va I VjA lU City/St/Zip Identification of Source Phone#:. _Fax »:, Collection Point_&Pk’£ 1 CA. CH. Bl?- (^eck#:. Amounts.

BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLEZSOLID ANALYSES Lab #:_______V / Lab#:____________________ (circle tests) 1. Heterotrophic Plate 32 Trihalomethanes (524) 1^ 1. Purgeable Halocarbons (624/8260) Count (bdmbdialysis & all others) Volatile Halocarbons (524) 2. Purgeable Aromatics (624/8260) 2; Goliforrn P/A' (public supplies) 32 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) j 5. Microscopic Pesticides (507) 6. PCB’s (Arochlors) (608/8080) J ff/l/lacroscopic 7. API 8. Other:_____ > ? PestieWes/PCB screen (508) PCB as Decachlorobiphenyl (508A) Herbicides (515) Y 7. Herbicides (SM-18/6640: 8151) 8. Other Pesticides (SM-18/6630) ' 9. Petroleum Hydrocarbon Scan (310-13) Pesticides (525) ■< 10. Glycols in Water Refrigerated? .yes no Carbamate Pesticides (531) 11. Acid Extractables (625/8270) Glyphosate (547) 12. Base Neutral Extractables (625/8270) Chlorinated?:. ves no 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) Total Chlorine Res: .mg/L 17. Petroleum/Hydrocarboh Scan (310-13) 17. PCB’s (Arochlors) (DEF) j

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INORGANIC ANALYSES REQUESTED - Lab#: P 7/ (circle tests) 1. Color 20. Acidity Aluminum /^Potassium 2. Turbidity 21. Alkalinity, as CaCOs 40. Antimony ^.iSelenium 3. pH 22. Bromide 41. Arsenic ^Silver 4. Conductivity 23. Bromate/Chlorate/Chlorite 42. Barium 62. >odium 5. Corrosivity (temp: .’C) 24. Chloride Beryllium 63. 'hallium 6. BOD (5 day) 25. Cyanide Boron 64. /anadium 7. Soluble BOD (5 day) 26. Fluoride Cadmium \g5.jfeinc 8. Carbonaceous BOD (5 day) 27. Hardness, Total as CaCOa 46. Calcium, as CaCOs 9. Chemical Oxygen Demand 10. Dissolved Oxygen 11. Total Organic Carbon 12. Total Organic Halides 28. Nitrogen. Ammonia as N 29. Nitrogen. Nitrate as N 30. Nitrogen. Nitrite as N 31. Nitrogen. Total Kjeldahl as N i Calcium, Ca*’ Chromium, Total 49. Chromium, Hexavalent 50. Cobalt 66. Metals/CN 67. Volatiles 68. Semi-volatiles 69. Pesticides/PCB’s 13. Solids.'Percent (%) 32. Oil and Gregsa-,_ . , Copper 70. Disk Deliverablea 14. Solids. Settle.able 33. Phenol 52.Uron TCLP 15. Solids. Suspended 34. Phosphorus. Total as P 53.1Lead 71. TCLP-Metals 16. Solids. Total 35. Phosphorus. Ortho as P 54. jMagnesium 72. TCLP-Pesticides 17. Solids, Total Dissoived 36. Sulfates ! 55.^anganese 73. TCLP-Herbicides 18. Solids, Total Volatile 37. Surfactants 56./Morcury 74. TCLP-Volatiles 19. Other:_______________ __ 38. UV254 57J Molybdenum 75. TCLP-BNA's W Nickel

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