NYC 9/11 Public Portal Document
Time/Date Set:
Sämple Type (circle one):
.Potable
3. Non-Potable Treated
2.
Non-Potable
4: Other
Time/Date Collected:
0851
: 11.20•01
Collected By: D). SCOTT:
Agency Code:
Collected From:
Location's/Individual's Name NYC DEP
street 19 WEST LAKE DRIVE
City/SV/Zip
VALHALLA, NY 1595
Identification of Source
Collection Point_
AT LEFE
ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORMP 14T
WESTCHESTER COUNTY LABORATORIES AND RESE ÁRCH
2 Dana Road, Valhalla, New York 10595
:.. (914) 593-5575
NYS-ELAP No 10108*
; Form A-70 (rev. 1/96)
Q14, Q915, Q*0945, C0567
BOMe#s P1085, PI09Z, REE1Z KE916
Chain of Custody?
KOYC
Comments: "
_yes ÷no KEU4LBLANK
K•VOCTRT
PWS #:_
: Source ID:
iType Deścriptor:_
Bill to:
Name/Company
Street
City/St/Zip.
Phone#:
Fax #:
CA, CH, BI?
Check#:
Amounts
BACTERIOLOGICAL ANALYSES
ORGANIC POTABLE ANALYSES
ORGANIC NONPOTABLE/SOLID ANALYSES
Läb#:
(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?:
Free Chiorine Res
.YeS_.
_now=
Total Chlorine Res:
_mg/L';
pH
Lab #:
(circle lests)
4651
Trihalomethanes (524)
.1. Purgeable Halocarbons (624/8260)
Volatile Halocarbons (524)
2. Purgéable Aromatics (624/8260)
Volatile Aromatics (524)
Total Trihalomethane Potential (510)
3.
Acrolein & Acrylonitrile (624)
4.
Phthalates (606/8060)
5.
6
8.
Microextractables. (504)
5.
Organochlorine Pesticides (608/8080)
Pesticides (507)
PCB's (Arochlörs) (608/8080)"
Pesticides/P.CB screen (508)
7: Herbicides (SM-18/6640, 8151)
PCB'as Dècachlorobipheny! (508A)
8. Other. Pesticides (SM-18/6630):
¿Herbicides (515).
9:, Pefroleum Hydrocarbon Scan (310-13)
*Pesticides (525)
10. Giycols in Wấter
11:Carbamate Pesticides (531)
11) Acid Extractables: (625/8270)
12. Glyphosate (547);
12. Base Neutral Extractables (625/8270)
13: Diquät (549)
[3/GC/MS Unknown Scan.
14. Chlorination Disinfection Byproducts_(551):
14. Purgéable Halocarbons (DEF.
15. Haloácetic Acids (552)
15. Purgeable Aromatics (DEF)
16. Other Pesticidés (SM-18/6630)
16. Pesticides (DEF)
17. Petroleum/Hydrocarbon Scan (310-13)
17. P.CB's (Arachlors) (DEF)
pretahs
INORGANIC ANALYSES REQUESTED
BLab#:
(circle tests)*
Color:
2.:Turbidity
20
idity
Alkalinity, as CaCO3
22
4.
Conductivity
5.
Corrosivity (temp
°C)
6:- BOD (5 day),
7Soluble BOD (5 dãy)
Cotbonaceoys BOD (s day).
Chemical Oxygen Demand.
10. Dissolved Oxygen»
113Total Organic Carbon
12. Total Organic Halides
13 Şölids, Percent (%);
'14 Solids" Settleable)
.15.Solids; Suspended:
:16÷Sölids+Totälı
5117: Solids: Total Dissolved)
-18: Solas
Totatvoi
19%Other
Bromide
Bfomate/Chlorate/Chlorite
Chioride
25: Cyanide
26. Fluoride"
27. Hardness, Total as CaCOз
28. Nitrogen, Ammonia as N..
29.Nitrogen, Nitraté as N
30 Nitrogen, Nitrite as N
31
•Nitrögen, Tota! Kjeldahl as N.
32NOiLand Grease"
331Phenội}
34+Phosphorus: Total asPA
35: Phosphorüs, Ortho as P
36 Sulfates,
37, Sürtàcłants)
38 LV254
Tinö
39. Aluminum
40JAntimony
41. 'Arsenic
Barium
Beryllium
44. Boron
45. Cadmium
46. Calcium, as CaCO3
47. Calcium, Cat2:
48. Chromium, Total4,
49. Chromium, Hexavalent
50pCobalt1
51; Copper
ron
Leadi
54 Magnesiüm3
(55 Manganese;
56Mercury
«Molybdenum)
.58.Nickeli
59. Potassium
60. Selenium
61:Silver
62. Sodium
63. Thallium
64. Vanadiur
65. Zinc
CLP
'66. Metals/CN
67
Volatilesy
68. Semi-volatiles x
'69 Pešticides/PCB's
170 DisK Deliverables
TCLP)
71, TCLP-Metals
72. TCLP Pesticides
73,TCLP Herbicides;
;74!ŤCLРVõlätilés!
175.ȚCLP-BNA'Ś
NYC-WTC
000070963
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