NYC 9/11 Public Portal Document
Westchester County
ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM
WESTCHESTER COUNTY LABORATORIES AND RESEARCH
2 Dana Road, Valhalla, New York 10595
(914) 593-5575
Time/Date Set:
Sample Type (circle one):
1.
Potable
3. Non-Potable Treated
2. Non-Potable
4. Other
Time/Date Collected:(740
Collected By:
UMал
н.1=
Agency Code:
Collected From:
Location's/Individual's Name
NYL NOCH
Street.
V.CAL
City/St/Zip,
Identification of Source
Collection Point
MaTAO
4-224
Bottle #'s:
Chain of Custody?
Comments;
PWS #:_
Billto:
Name/Company
Street
City/St/Zip
Phone#:
CA, CH. BI?
_yes
Source ID
BACTERIOLOGICAL ANALYSES
ORGANIC POTABLE ANALYSES
Lab#:
(circle tests)
1. Heterotrophic Plate
Count (hemodialysis & all others)
2. Coliform P/A (public supplies)
3. Coliform MPN (priv well, raw, stp)
4. Fecal Coliform (all samples)
5. Microscopic
6. Macroscopic
7. AP:
8. Other:
Refrigerated?
yes.
Chionnated?:
yes.
_no
Free Chiorine Res:
mg/L
Total Chlorine Res:
_mg/L
Lab #:
(circle lests)
Trihalomethanes (524)
Volatile Halocarbons (524)
Volatile Aromatics (524)
Total Trihalomethane Potential (510)
5.
Microextractables (504)
Pesticides (507)
Pesticides/PCB screen (508)
PCB as Decachlorobiphenyl (508A)
9
Herbicides (515)
10.)Pesticides (525)
TT. Carbamate Pesticides (531)
12. Glyphosate (547)
13. Diquat (549)
14. Chlorination Disinfection Byproducts (551)
15. Haloacetic Acids (552)
16. Other Pesticides (SM-18/6630)
17. Petroleum/Hydrocarbon Scan (310-13)
рH
INORGANIC ANALYSES REQUESTED - Lab#:
(circle tests)
1. Color
2
Turbidity
pH
Conductivity
5
Corrosivity (temp:_
°C)
6
BOD (5 day)
7
Soluble BOD (5 day)
8. Carbonaceous BOD (5 day)
9. Chemical Oxygen Demand
10. Dissolved Oxygen
11. Total Organic Carbon
12. Total Organic Halides
13. Solids, Percent (%)
14. Solids, Settleable
15. Solids, Suspended
16. Solids, Total
17. Solids, Total Dissolved
18. Solids. Total Volatile
19. Other:
20. Acidity
21. Alkalinity, as CaCO3
22. Bromide
23. Bromate/Chlorate/Chlorite
24. Chloride
25. Cyanide
26. Fluoride
27. Hardness, Total as CaCO3
28. Nitrogen, Ammonia as N
29. Nitrogen, Nitrate as N
30. Nitrogen, Nitrite as N
31. Nitrogen, Total Kjeldahl as N
32. Oil and Grease
33. Phenol
34. Phosphorus, Total as P
35. Phosphorus, Ortho as P
36. Sulfates
37. Surtactants
38. LIV254
39. Aluminum
40. Antimony
41. Arsenic
42. Barium
43. Beryllium
44. Boron
45. Cadmium
46. Calcium, as CaCes
47. Calcium, Ca*?
48. Chromium, Total
49. Chromium, Hexavalent
50. Cobalt
51. Copper
52. Iron
53. Lead
54. Magnesium
55. Manganese
56. Mercury
57. Molybdenum
58. Nickel
NYC-WTC_000070503
NYS-ELAP No 10108
FormA-70 (rov.196)
Type Descriptor:
Fax #:
Check#:
Amount$
ORGANIC NONPOTABLE/SOLID ANALYSES
1. Purgeable Halocarbons (624/8260)
2
3
4
Purgeable Aromatics (624/8260)(
Acrolein & Acrylonitrile (624)
Phthalates (606/8060)
Organochlorine Pesticides (608/8080)
PCB's (Arochlors) (608/8080)
7. Herbicides (SM-18/6640; 8151)
8. Other Pesticides (SM-18/6630)
9. Petroleum Hydrocarbon Scan (310-13)
10. Glycols in Water
11. Acid Extractables (625/8270)
12. Base Neutral Extractables (625/8270)
13. GC/MS Unknown Scan
14. Purgeable Halocarbons (DEE
15. Purgeable Aromatics (DEF)
16. Pesticides (DEF)
17. PCB's (Arochlors) (DEF)
Mex
ds
59. Potassium
60. Selenium
61. Silver
62, Sodium
63. Thallium
64. Vanadium
65. Zinc
CLP
66. Metals/CN
67. Volatiles
68. Semi-volatiles
69. Pesticides/PCB's
70. Disk Deliverables
TCLP
71.TCLP-Metals
72. TCLP-Pesticides
73. TCLP-Herbicides
74, TCLP.Volatiles
75. TCLP-BNA'S
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