NYC 9/11 Public Portal Document
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ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM
III
UlKtchMtor County
Time/Date Set;
WESTCHESTER COUNTY LABORATORIES AND RESEARCH
2 Dana Road, Valhalla, New York 10595
(914) 593-5575 NYS-ELAPNo. 10108
Form A-70 (rev. 1/96)
Sample Type (circle one); C
j) Potable 3. Non-Potable Treated Bottle #'s:
2. Non-Potable 4. Other Chain of Custody? .yes no
Time/Date Collected;, f -g;: 52 ///zS / :z-oo 1 Comments;
Collected By;. M- Agency Code; PWS #;_________ Source ID; Type Descriptor;.
Collected From; Bill to.
Location's/lndividual’s Name Name/Company
Street_______________ Street__________
City/SVZip____________ City/SVZip
Identification of Source Phone#;, _______ Fax #;.
Collection Point I CA, CH, Bl? Check#; Amounts
. BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLE/SOLID ANALYSES
’ Lab#;______________________ Lab #;_______
. (circle tests)
1. Heterotrophic Plate
(drcle tests) /J
1. Trihalomethanes (524)
(
tTf> 1. Purgeable Halocarbons (624/8260)
Count (hemodialysis & all others) Volatile Halocarbons (524) 2. Purgeable Aromatics (624/8260)
2. Coliform P/A (public supplies) Volatile Aromatics (524) 3. Acrolein & Acrylonitrile (624)
3. Coliform MPN (priv well, raw, stp) 4. Total Trihalomethane Potential (510) 4. Phthalates (606/8060)
4. Fecal Coliform (all samples) 5. Microextractables (504) 5. Organochlorine Pesticides (608/8080)
5. Microscopic 6. Pesticides (507) 6. PCB’s (Arochlors) (608/8080)
6. Macroscopic 7. Pesticides/PCB screen (508) * 7. Herbicides (SM-18/6640; 8151)
7. API 8. PCB as Decachlorobiphenyl (508A) 8. Other Pesticides (SM-18/6630)
8. Other;___________________ 9. Herbicides (515) ( 9. Petroleum Hydrocarbon Scan (310-13)
10. Pesticides (525) I 10. Glycols in Water;
Refrigerated? yes. no 11. Carbamate Pesticides (531) 11. Acid Extractables (625/8270)
12. Glyphosate (547) I^Base Neutral Extractables (625/8270)
'Chlorinated?; .yes no 13. Diquat (549) tv ^^GC/MS Unknown Scan
T 14. Chlorination Disinfection Byproducts (551) .14. Purgeable Halocarbons (DEF)
’ Free Chlorine Res;. .mg/L 15. Haloacetic Acids (552) ’I- .... .15. Purgeable Aromatics (DEF)
16. Other Pesticides (SM-18/6630) | . 'l 6.’Pesticides (DEF)'. .
;Total Chlorine Res; .mg/L 17. Petroleum/Hydrocarbon Scan (3i0-13) 17.’PCB’s (Arochlors) (DEF) >
INORGANIC ANALYSES REQUESTED - Lab#;. A
(circle tests)
1. Color 20. Acidity ^39AAIt ninum sa Potassium
2. Turbidity 21. Alkalinity, as CaCOa AO.lAn^ony 60jSelenium
3. pH 22. Bromide 41. Uranic- Silver
4. Conductivity 23. Bromate/Chlorate/Chlorite 42.feaSum ea^Sodium
5. Corrosivity (temp; .’C) 24. Chloride M3<Bewllium ^/Thallium
6. BOD (5 day) 25. Cyanide 44. Bo*n J54-Vanadium
'Si
7. Soluble BOD (5 day) 26. Fluoride 45. CaShfiium 65yZinc
8. Carbonaceous BOO (5 day) 27. Hardness. Total as CaCOa 46. Calcium, as CaCOs CLP
9. Chemical Oxygen Demand 28. Nitrogen, Ammonia as N Calcium, Ca*’ 66. Metals/CN
10. Dissolved Oxygen 29. Nitrogen. Nitrate as N Chromium, Total 67. Volatiles
11. Total Organic Carbon 30. Nitrogen. Nitrite as N 49. Chromium, Hexavalent 68. Semi-volatiles
12. Total Organic Halides 31. Nitrogen. Total Kjeldahl as N '50| Cobalt 69. Pesticides/PCB’s
13. Solids, Percent (%) 32. Oil and Grease 511 Copper 70. Disk Deliverables
14. Solids, Settleable 33. Phenol 52.1 Iron T£L£ r-
15. Solids, Suspended 34. Phosphorus, Total as P _^Load 71. TCLP-Melals
16. Solids, Total 35. Phosphorus, Ortho as P Magnesium 72. TCLP-Pesticides T.'
17. Solids, Total DissoNed 36. Sulfates S^Manganese 73. TCLP-Herbicides
-W. Solids. Tola11 Volatile 37. Surfactants 56.jMercury 74. TCLP-Volatiles
Other; S 38. IIV254 57.lMolybdenum 75. TCLP-BNA's
Nickel
NYC-WTC_00007b899
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