NYC 9/11 Public Portal Document
23 Al:42
ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM
WESTCHESTER COUNTY LABORATORIES AND RESEARCH
2 Dana Road, Valhalla, New York 10595
Westchester County
(914) 593-5575
ne/Date Set:
Sample Type (circle one):
(1..Potable
3. Non-PotableTreated
2. Non-Potable
4. Other_
Time/Date Collected:
Collected By:
Lab
Collected From:
Location's/Individual's Name
Mzzler
Agency Code: Nelvi
Field Blank
Street
City/StZip
dentification of Source
Collection Point
10-1/22
Bottle #'s:
P1143,Q652
Chain of Custody?
yes
no
Comments:_
PWS#:
Source ID:_
Bill to:
Name/Company
Street
City/St/Zip
Phone#:
Fax #:
CA, CH, BI?
Check#
NYS-ELAP No. 101(
Form A-70 (rev. 1/96)
Type Descriptor:
Amount$
BACTERIOLOGICAL ANALYSES
ORGANIC POTABLE ANALYSES
ORGANIC NONPOTABLE/SOLID ANALYSES
Labl:
(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
* АР:
Other.
Refrigerated?
yes
Chlorinated?:
Lyes
no
Free Chiorine Res:
mg/L
Total Chlorine Res:_
mg/L
Lab #:
(circle tests)
1. Trihalomethanes (524)
2.
Volatile Halocarbons (524)
3.
Volatile Aromatics (524)
4.
Total Trihalomethane Potential (510)
5.
Microextractables (504)
6
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)
3
Acrolein & Acrylonitrile (624)
4.
Phthalates (606/8060)
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)
прH
INORGANIC ANALYSES REQUESTED - Lab#:
(circle tests)
Color
Turbidity
pH
Conductivity
Corrosivity (temp:
°C)
BOD (5 day)
Soluble BOD (5 day)
Carbonaceous BOD (5 day)
Chemical Oxygen Demand
Dissolved Oxygen
Total Organic Carbon
otal Organic Halides
Solids, Percent (%%)
blids, Settieable
Sbllds, Suspended
Mlids, Total
Bllds, Total Dissolved
Blids, Total Volatile
JHer:
20. Acidity
21. Alkalinity, as CaCO3
22. Bromide
23. Bromate/Chlorate/Chlorite
24. Chloride
25. Cyanide
26. Fluoride
27. Hardness, Total as CaCO,
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. UV254
39. Aluminum
40. Antimony
41. Arsenic
42. Barium
43. Beryllium
44. Boron
45. Cadmium
46. Calcium, as CaCOs
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_000070828
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