NYC 9/11 Public Portal Document
Westchoster County
ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM0Y 30
WESTCHESTER COUNTY LABORÄTORIES AND RÉSÉÁRCH
2 Dana Road, Valhálla,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:
11/20/01
Collected By:(Lrib
Agency code:NE:iNC
Collected From:
Location's/Individual's Name
Field Plank
Street
City/St/Zip,
Identification of Source.
Collection Point
FB - 11/20/u
:NYS-ELAP No. 10108 :*
: Form A-70 (rev. 1/96)
Bottle #'s:
Pil2,
942
Chain of Custody?
_yes
_no
Comments:..
PWS #:
Source ID:
_Type Descriptor:
BIll 1o:
Name/Company
Street
City/St/Zip.
Phone#:
Fax#:
CA, CH, BI?
Check#:
Amount$
BACTERIOLOGICAL ANALYSES
ORGANIC POTABLE ANALYSES
ORGANIC NONPOTABLE/SOLID 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
no
Chiornated?: :
_yes__ no
Free Chlorine Res:
Totäl Chlorine Res:
mg/L.
_mg/L:
Lab #:
(circle tests)
1: Trihalomethanes (524)
2: "Volațile Halocarbons (524)"
Volatile Aromatics (524)
4._ Total Trihalomethane Potential (510)
5% Microextractables (504)
6. Pèsticides.(507)
Pesticides/PCB screen (508)
8
PCB as Decachlorobiphenỹ! (508A) •
9f Herbicides ($15)
10. Pesticides (525)}
1 11: Carbämatế Pesticides (531)*
$12: Glyphosate (547)
13. Diquat (549):
14. Chlorinätion Disinfectión, Byproducts" (551)
15. Haloäcetic Acids (552)*
16.'Other Pesticides (SM-18/6630)
$17. Pétroleum/Hydrocarbon Scẩn (310-13)
1. :Purgeable Halocarbons (624/8260) :
2.
Purgeable Aromatics (624/8260).
3.
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)
Petrolum Hÿdrocarbon Scán (310-13)
:10. Glycois in Water
11: Acid Extractablés' (625/8270)*:
12:Base Neutral Extractables (625/8270)
13. GC/MS Unknown Scan
T4 Purgeable Halocarbons. (DEF):
15. Purgeable Aromatics (ÖEF)
16. Pesticides (DEF)
17. PCB's (Arochlors) (DEF)
ph
INORGANIC ANALYSES REQUESTÉD Lab#:
(circle tests)
*1.
Color
20- Acidity
Turbidity
2T Alkálinity, as CaCo:
pH
22;Bromide
Conductivity
23. Bromate/Chlorate/Chlorite
Corrosivity (temp:_
,24* Chloride
6.
BOD (5 day)
25. Cyanide
7.
: Soluble BOD.(5 day)
26: Fluoride
8
Carbonaceöus. BOD. (5 day)
9.
Chemical Oxygen Demand
27:Hardhess, Total as CaCOs
28. Nitrogen, Ammönia_as N:
10. Dissolved Oxygen
29: Nitrogen: Nitrate as'N
•11, Totàl Organic Carbon
30! Nitrogen: Nitrite as Nº
112: Total Orgänic Hälides
31. Nitrogen; Total Kjeldahl as N,
¡13. Solids, Percent (%),
32
Oil,and Grèase
14. Solids Settleable"
33. Phênol,
{15.;Solids Suspended,
•34! Phosphorus: Totalas:P:
16! Solids, Total:
¡17)Solids Total Dissolved
35:PhosphorussOriho,as.P:
36, Sulfates;
$18, Solids! Total,Volätile;
37, Surlactants)
19%Otherz_
з8½LỈV254
39. Aluminum
40. Antimony
41. Arsenic
* 42. Barium
43. Beiyllium
44. Boron •
45: Cadmium
46: Calcium, as CaCOj
47. Calcium, Cấ?-
•-.
*48: Chrömium Total:
49) Chromium, Hexavalent!
51 Copper:
52! tron:
53:Lead)
54 Magnesium,
55: Manganese:
:56‹Mercurý/
57.-Molybdenümi
58. Nickel)
59. Potassium
60. Sëlenium
61. Silver
62. Sodium
63. Thallium
•64. Vanädium
65. Zinc
CLP
66. Metäls/CN.
i67. Volatiles
68.Semi-volatiles.
69 Pesticides/PCB's:
70. Disk Deliverables
FTCLPA
71-TCLP.-Metals
72,TCLP-Pesticides
73 TCLP Hèrbicides,
74. TCLP-Volátiles)
75: TCLP-BNA'S!
NYC-WTC_000070962
OCR can misread numbers and units. Confirm readings against the page image before using them.