NYC 9/11 Public Portal Document
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VY. ■'7- , J .ENVIRONMENTAL SERVICES SAMPLE'SUBMIS&ON FORM? A P
IM
y. . Uleithesta- Countv
T. ''Time/Date Set:
WESTCHESTER COUNTY LABORATORIES ANb'RESEA'RCH ’
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'2 Daria Road, Valhalla,.New York 10595
y -'. (914)593-5575 ■ ' .
J
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. NYS-ELAP No. 10108 .
Form A-70 (rev. 1/96)
K
.Sample Type (circle one)>
■■ 3. Non-Potable Treated
/2.' Non-Potable 4. Other; _ ' Chain of Custody? .yes no;
Time/Date Collected;. .0950 U-20-o I Comments:
Collected Bv: L- Agency Code: _ ' PWS __________ ’ Source ID: Type Descriptor: ■
Collected From: Bill to:
Lbcation's/lndividual’s Name OCP
Name/Company
Street • Wc .7Lz-f "b< . wC
- Street_____________
Citv/SVZip . iOS 9 ST
City/SVZip
Identification of Source___________________________ Phone#: ______ Fax #:
■Collection Point KT / ■i j . I CA. CH. Bl?. Check#: Amounts,
BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLE/SOLID ANALYSES
lab#:-'. - ' ■ • ' Lab #:__________________
.(circle'tests) . (circle tests)
1. Heterotrophic Plate 1. Trihalomethanes (524) 1. Purgeable Halocarbons (624/8260),
; Count (hemodialysis & all others) ■ 72* Volatile Halocarbons (524) 2. Purgeable Aromatics (624/8260)
2. Coliform P/A (public supplies) ; Volatile Aromatics (524) 3. Acrolein & Acrylonitrile (624) -
.3. Coliforrh MPN (priv well, raw. stp) ■ -4. Total Trihalomethane Potential (5i0) ... .4.Phthalates (606/8060)
3. Fecal Coliform (all samples) . 5. Micrdejdractables (504) 5?. Organochlorine Pesticides (608/8080) ■
5. Microscopic Pesticides (507) ' . ' ‘ 6. ' PCB's (Arochlors) (608/8080) . .
‘6.,Macroscopic Pesticides/PCB screen (508) 7.’ -Herbicides (SM-18/6640; 8151)
7. API ■ . . ,8. PCB as Decachlorobiphenyl (508A). .8. Other Pesticides (SM:18/6630)
■ ■< • 1: ’g^Herbicides (515) ' ' 9. - Petro)eum'Hydrocarboh Scan (310-13) ' '
■8. CXher:.1
'^/Pesticides (525) .. " ‘lO./Glycols in Water' "
Refrigerated? ves Ino
I / rk Carbamate Pesticides (531) 11. Acid Extractabies (625/8270)
,'.12. Glyphosate (547) ' 12...Base Neutral Extractabies (625/8270) ■
Chidnnated?: yes no .-'13. .Diquat (549) ' . { yjyGC/MS Unkndwn Scan
4. Chlorination Disinfection Byproducts (551) ' 14. Purgeable Halocarbons.(DEF)
Free Chlorine Res; mg/L; fl5. Haloacetic Acids (552) 15. Purgeable Aromatics (DEF)
.7
16. Other Pesticides (SM-18/6630) 16. Pesticides (DEF)
Total Chlorine Res: ' mg/U< ■^17. Petroleum/Hydrocarbon Scan (310-13) 17. PCB's (Arochlors) (DEF)
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INORGANIC ANALYSESREQUEST£D|Lab#: X 7 y( ~
(circle tests) . " .
1. ; Color ■ 7*'. - - - -.
39. Aluminum 59. Potassium
2. Turbidity ■ - 2h-^lkalinity, as CaCOa @) Antimony 60. Selenium
3. pH ■ , '2^- Bromide ■ 41. Arsenic' 61. Silver
4. Conductivity '’2^.-Bf’dmate/Chlorate/Chlorite Barium ■eg. Sodium .
5. Corrosivity (temp: ' “C) ■'2’^; CKl'oride <0 Beryllium Thallium
6." BOD (5-day) .. 25. Cyanide 44. Boron ' 64. Vanadium
7. .-Soluble BOD (5 day) . 26.'Fluoride ■ ■ . .45. Cadmium .65. Zinc
8. Carbonaceous BOD, (5 day) 27.‘Hardfiess, Total as CaCOs . 4_6. Calciurp, as CaCOs
9., '.Chemical Oxygen Demand , 28. Nitrogen, Ammonia as N ’ 47.,Calcium, Ca'^7 .~ ~ • '66. Metals/CN
’'10.'.Dissolved Oxygen '29. Nitrogen, Nitrate as N 48'. Chromiunn, Total • 67. Volatiles -
1.7Total Organic Carbon,' 30.'Nitrogen, Nitrite'’as N 4^_Ch'romium, Hexavalent.? . [ 68.‘Semi-volatiles
■ 12; TotaLOtgahic Halides ' 31 .^Nitrogen, Jotal.Kjeldahl as N. gffl.Cobalt ’ ■ ’ '69.iRes*ticides/pCB's, .•
13? Solids, J’ercent (%)/ ®P10£ea-se; 51? Copper ■70. bisi< PdlweraBl^ 7
. 14r Solicis,'Settleable:
.'.Is'- SolidJ. Suspended,
;33.',Phenb!,’ ' . - ©Iron-" JCLPj 7“ ’ -
SVPhosphorus.'Total'asPl 'T^CTCC^Metals,
d6?Solids7T3taP ' S^sPhosphoru^^rthp'as'^ • • I^TCL^Pesticid^
. 54,’ Ma'gnesiurn?'
.175Sblids7otai,Dis^^,» , ’ @).Mangahes^.. * ■; ;73pT^P-Herbicides.
^18^ds,Tot^l^il^ fU'-’LQLp-.Volale^
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NYC-WTC_000070965
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