NYC 9/11 Public Portal Document
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ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM
WESTCHESTER COUNTY LABORATORIES AND RESEARCH
Time/Date Set:________________________________
2 Dana Road, Valhalla. New York 10595
(914)593-5575
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NYS-ELAP No. 10108
Form A-70 (rev. 1/96)
Sample Type (circle one):
Potable 3. Non-Potable Treated
2. Non-Potable 4. Other ________________ Chain of Custody? .yes no
Time/Date Collected: ///^ 0 /
Comments:
Collected Bv: Agency Code: WS #:________ Source ID: Type Descriptor:
Collected From: Bill to:
Location's/lndividual’s Name k Name/Company
Street______ _________________________________ _____ Street__________
Citv/SVZip ___________ __ _________________ _ City/St/Zip
Identification of Source ■ tfAr* k/rj Phone#:________ Fax #:
Collection Point ' I CA,'CH, Bl? ~ Check#: Amounts.
■'I ■
BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES < ORGANIC NONPOTABLE/SOLID ANALYSES
,'Lab ____ ■
(drclelesls) (circle tests) :
1. Heterotrophic Plate . " 1. Trihalomethanes (524) ' 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)
i ■
6. Macroscopic -• , <2? Pesficides/PCB screen (508) - 7. Herbicides (SM-18/6640; 8151)
7. API . 8. PCB as Decachlorobiphenyl (508A) 8. Other Pesticides (SM-18/6630)
8. Other: _______ ;_______ L;- • • Herbicides (515)' ■ ' V 9. Petroleum Hydrocarbon Scan (310-13)
Pesticides (525) / 10. Glycols in Water
Refrigerated? yesj no ; -11. Carbamate Pesticides (531) 11. Acid Extractables (625/8270)
;12. Glyphosate (547) 12. Base Neutral Extractables (625/8270)
Chlorinated?: yes no 3. Diquat (549) (^GC/MS Unknown Scan
.14. Chlorination Disinfection Byproducts (551) 14. Purgeable Halocarbons (DEF)
Free Chlorine Res: .mg/L ■ ;15. Haloacetic Acids (552) 15. Purgeable Aromatics (DEF)
.-.16. Other Pesticides (SM-18/6630) 16. Pesticides (DEF)
Total Chlorine Res: .mg/L; ; -17. Petroleum/Hydrocarbon Scan (310-13) 17. PCB’s (Arochlors) (DEF)
pH ti )'
V-d.
INORGANIC ANALYSES REQUESTED ^tab#:
■ • - '’'ic ' «’* -
(circle tests)
1. Color .2fe-Acidity 3^ Aluminum 59. Potassiurn
2. Turbidity 2)5 Alkalinity, as CaCOs 40.1 Antimony . 60. Selenium •
3. pH ;22j. Bromide 41. Arsenic .61 ..Silver
4. Conductivity 23.;' Brbmate/Chlorate/Chlorite 42.fBarium 62. Sodium
5. Corrosivity (temp: .°C) 24j^C^loride M 3/Beryllium 63. Thallium .
6. BOD (5 day) 25;C)(f^nide 44. Boron 64. Vanadium
7. Soluble BOD (5 day) 26.'’Flu'oride 45. Cadmium ; 65>Zinc
8. Carbonaceous BOD (5 day) 27. Hardness, Total as CaCOa 46. Calcium, as CaCOs CLP
9. Chemical Oxygen Demand 28. Nitrogen, Ammonia as N 47, 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 Kj^dahl as N /50\Cobalt 69. Pesticides/PCB's
13. Solids. Percent (%) 32. Oil and Grease 51.KJopper 70. Disk Deliverables
14. Solids. Settleable 33. Phenol 52. Iron TCLP
15. Solids, Suspended 34. Phosphorus. Total as P S^ead 71.TCLP-Metals
16. Solids, Total 35. Phosphorus, Ortho as P 54. Magnesium 72. TCLP-Pesticides
17. Solids, Total Dissolved 36. Sulfates /SsV/langanese 73. TCLP-Herbicides
18. Solids. Totatyolatile 37. Surfactants 56. i^ercury 74. TCLP-Volatiles
•19?Other: --Vn 38. IIV254 57, Molybdenum 75. TCLP-BNA’s
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