NYC 9/11 Public Portal Document
ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM'3
A H:12
WESTCHESTER COUNTY LABORATORIES AND RESEARCH
2 Dana Road, Valhalla, New York 10595
Westchester County
*ime/Date Set:
Sample Type (circle one):
1. Potable
3. Non-Potable Treated
2. Non-Potable
4. Other
Time/Date Collected:
Lo SO
Collected By:V
Collected From:
Location's/Individual's Name AN/C DCP
Street
City/St/Zip
Veilhellc Anl
Identification of Source
Collection Point_
(914) 593-5575
NYS-ELAP No. 1015
Form A-70 (rev. 1/9c,
с 0729. 4320.267. Рн, 1133
Bottle #s: L 1012,cikc,508,
Chain of Custody?
yes
11-22-01
Agency Code:
Comments:
PWS #:_
Source ID:
Type Descriptor:
Bill to:
Diei+
100
Name/Company
Street
City/St/Zip
Phone#:
Fax #:
DEl 102
CA, CH. BI?
Check#:
Amount$
BACTERIOLOGICAL ANALYSES
ORGANIC POTABLE ANALYSES
ORGANIC NONPOTABLE/SOLID ANALYSES
Lab#r
(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
2 Other,
Refrigerated?
_yes
Chionnated?:
_yes
Free Chiorine Res:
mg/L
Total Chlorine Res:
mgL
Lab #:
(circie tests)
Trihalomethanes (524)
Volatile Halocarbons (524)
3
Volatile Aromatics (524)
Total Trihalomethane Potential (510)
Microextractables (504)
Pesticides (507)
7.
Pesticides/PCB screen (508)
8
PCB as Decachlorobiphenyl (508A)
9
Herbicides (515)
10. Pesticides (525)
11. 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)
1.
Purgeable Halocarbons(624/8260)
2.
Purgeable Aromatics (624/8260)
Acrolein &Acrylonitrile (624)
4.
Phthalates (606/8060)
5.
Organochlorine Pesticides (608/8080)
6.
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 (DEF)
15. Purgeable Aromatics (DEF)
16. Pesticides (DEF)
17. PCB's (Arochlors) (DEF)
рH
INORGANIC ANALYSES REQUESTED Lab#
(circle tests)
Color
Turbidity
3.
pH
Conductivity
Corrosivity (temp:
_°C)
BOD (5 day)
Soluble BOD (5 day)
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
1. Solids, Suspended
i6. Solids, Total
17. Solids, Total Dissolved
18. Solids, Total Volatile
19. Other:
20. Acidity
M21
Aikalinity, as CaCOs
22. Bromide
23. Bromate/Chlorate/Chlorite
24, Chloride
25. Cyanide
26. Fluoride
27. Hardness, Total as CaCOs
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. Surfactants
38. UIV254
39. Aluminum
40/ Antimony
ulals
41. Arsenic
42. Barium
43. Beryllium
44. Boron
45. Cadmium
46. Calcium, as CaCO3
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
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
NYC-WTC_000070826
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