NYC 9/11 Public Portal Document
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RONMENTAL SERVICES SAMPLE SUBMISSION FORM
8TCHESTER COUI^ LABORATORIES AND RESEARCH
2 Dana ReSd.Walhalla, New York 10595
NYS-ELAP@1O8
(914) 593-5575
Time/Date Set: Form A-70 (rev/J/86)
^mple Type (circle one):
Gz Potable 3. Non-Potable Treated
Boni. rr Z’X.cr '________iiL-
2. Non-Potable 4. Otheu___,____________________ Chain of Custody? .yes .no
Time/Date Co^eA Comments:
Collected By: Aaencv Code: PWS#:_________ Source ID: Type Descriptor;£S___
Collected From: Bill to:
Location's/lndividuars Name. Name/Company ____________
Street__________________ Street__________
City/St/Zip_______________ Citv/St/Zip
Identification of Source. Phone»:_ Fax
Collection Point I CA, CH. Bl? Check#:
BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLE/SOLIDj
MM
Lab __________
(drctetesttj' , 'Yg;?', (circtetosts) ' i-
1. Hetprotrophic Plate . Ttihalorinelhanes (524) 1. Purgeable Halocarbons (624/8^6o:
C<^nt (hemodialysis & all,others) . m VUUIIIUI (524t~ 2. Purgeable Aromatics'(624|^|^^^^^S
2. Coniform P/A (public supplies) jfnintilo Arei^iatieo (Eai1).-> 3. Acrolein & Aeiyionitril«''(62^''tl^^§^^
3. Coli\rm MPN .ipriv well, raw. stp) / 4. Total Trihalomethane Potential (510) 4. Phthalates (606/8060) '
4. Fecal Coliform (all samples) 5. Microextractables (504) 5. Organdchlorine Pesticides (60iawi^"/^
5. Microscopic & Pesticides (507) '6. PCB’s (Arochlors) (608/8080) ^ ?; /
6. Macroscopic 0J2astiejdes/PG8-S6<»aa45Qg)^ 7. Herbicides (SM-18/6640:8151) ' •Y'
7. AP! 8. PCB as Decachlorobiphenyl (5'S8A) 8. Other Pesticides (SM-18/6630)
8. Other:___________________ a Herbicides (515) 9. Petroleum Hydrocarbon Scan (310-13)
PeBttejjjQH^> » 10. Glycols in Water
Refrigerated? ,yes no 11. Carbamate Pesticides (531) 11. Acid Extractables (625/8270)
12. Glyphosate (547) 12. Base Neutral Extractables (625/8270) ,
Chlorinated?: .yes-------- no 13. Diquat (549) GC/MS-Unknown Scair
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#: (J —
(circle tests) jj. V
1. Color 20. Acidity Aluminum 59. Potassium
2. T urbidity 21. Alkalinity, as CaCOs '401 Antimony 60. Selenium
3. pH 22. Bromide 41 Arsenic 61.’ Silver
4. Conductivity 23. BromateZChlorate/Chlorite 42.1 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 45. Cadmium 65. Zinc
8. Carbonaceous BOD (5 day) 27. Hardness, Total as CaCOs 46. Calcium, as CaCOs
9. Chemical Oxygen Demand 28. Nitrogen, Ammonia as N 47. Calcium, Ca*^ 66. Metais/CN
10. Dissolved Oxygen 29. Nitrogen, Nitrate as N ■■48?Chromium, Total 67. Volatiles
11. Total Organic Carbon 30. Nitrogen. Nitrite as N M9. Chromium, Hexavalent 68. Semi-volatiles
12. Total Organic Halides 31. Nitrogen, Total Kjeldahl as N zSOl Cobalt 69. Pesticides/PCB's
13. Solids. Percent {%) 32. Oil and Grease 51 .iCopper 70. Disk Deliverables
14. Solids. Settleabie 33. Phenol 52.jlron ISLE
15. Solids. Suspended 34. Phosphorus. Total as P <45/ Lead 71. TCLP-Metals
16. Solids. Total 35. Phosphorus, Ortho as P 54. Magnesium 72. TCLP-Pesticides
17. Solids. Total Dissolved 36. Sulfates zS5iManganese 73. TCLP-Herbicides
W. Solids. Total Volatile 37. Surfactants 56.|Mercury 74. TCLP-Volatiles
(19.Other: “Sa 38. UV254 57./Molybdenum 75. TCLP-BNA’S
. 58/ Nickel
NYC-WTC_000070784
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