NYC 9/11 Public Portal Document
Wesich
oster County
F Time/Date Sët:
Sample type (circle one).
Potable
3.-Non-Potable Trèated
:2. Non-Potab
4. Other
Timè/Date Collected:
0858,
1/:19.07
Collected By: 7.
5C5TT.
Agency Code:
Collected From:
Location's/individual's Naine NYC DEP
street | 19 WeSt LAKE DRIVE
City/St/Zip_:
• VALHALLA NY 10595
Identification öf Source
Collection Point_ /EL 18
ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM
WESTCHESTER COUNTY LABORATORIES AND RESEARCH
'2 Dana
ã Roäd, Valhallä; New York 10595
: "(914) 593-5575:
'NYS-ELAP No.10108
:Form A-70 (rev. 1/96)=
C0565 @878, QFGET8 QE8T
Bottle #'s: _
P7IO,PIV2 PRB1060 K9074
Chain of Custody?
no:Klk22(K4354,
Comments:
KVOCTRIP BLANK
• чд.
PW$ #:.
_Source ID:__Type Dèscriptor
Bill to:
Name/Company
Street
City/SVZip
Phone#
Fax #:
CA, CH, BI?-
Check#:
• Amount$
BACTERIOLOGICAL ANALYSES
ORGANIC POTABLE ANALYSES
ORGANIC NONPOTABLE/SOLID ANALYSES
Läb#
(circle iests)
1. Heterotrophic Plate
Count (hemodialysis & all others)
2.
Coliform P/A (public supplies)
3: Coliform MPN (priv well, raw, stp)
4.Fécal Coliform' (all samples)
5. Microscopic
6. Macroscopic
TARL
: 8. Other:
Rétrigerated?"_
_yes_
Chiornated?
_yes
Free Chiorine Res:
in
:Toral Chiorine Res:
no
mğ/l
mg/L:
ph.
Lab #:
(circle tests)
Trihalomethanes (524)
12.
4.
Völatile Halocärbons (524)
Volatile Aromatics (524)
Total Trihälomethane Potențial (5.10)
Microextractables (504)
Pesticides (507)
:Pesticides/PCB, screen (508)
8
P.CB as Decāchlorobipheny! (508A):
'Herbicides (515).
'Pesticides (525):
: Carbamate Pesticides (531)
12. Glyphosäte. (547)
13: Diquật (549)"
4. Chlorinätion'Disinfection, Byproducts, (551)
i15 Haloacetic Acids (552)
Other Pesticides (SM-18/6630)
[17. Petroleüm/Hydrocarbon Scan (310-13)
..1." Purgeable Halocärbons (624/8260) :
2. Purgeable Aroiatics (624/8260)
3. Acrolein & Acrylonitrile (624)
•4.
Phthalates (606/8060)•:
5.Organochiörine Pesticides: (608/8080):
PCB'ş (Arochorş)(60®/(080)
7.: Herbicides (SM-18/6640; 8151)
8.
Other Pesticides (SM-18/6630)
9. Petroløum Hydrocârbon 'Scan (310-13
i0. Glycols in Water
11. Acid Extractables (625/8270)
12. Base NøutralExtractables (625/8270)
(3GC/MS Unknown Scan
14. Purgeablé Halocarbons (DEF).-
15. Purgeable Aromatics (DEF)
16. Pesticides (DEF)
17: PCB's (Arochlors) (DËF)
INORGANIC ANALYSES REQUESTED
Lab#:
.(circie tests)
Colör
2.»Turbidity.
3. рн
4.
Conductivity
5. Corrosivity (temp:
6.
BOD (5 day)
°C)
7 Soluble BOD (5 day)
8
Carbonaceous BOD (5'day)...
Chemical Oxygen Demand,
10:Díssõlved Öxÿgën
'11. Total Organic. Carbon
12"Total Organic Halides
‹13 Solids,Perçènt:(%)!"
14
Sölids, Sětleable"
|15)Solids:Suspended,
(!64sclids, Total)}"
17. Solids: Total Dissolved)
18 Solidsi Totàl Volatile:
190h0r =56
Acidity
Alkalinity, as. ÇaCO3
Bromide
28 Bromate/Chlorate/Chlorite
Chloride
25 Cyanide
26. Fluoride:
27. Hardness, Total as CaCO3,
28. Nitrogen, Ammonla asN.
29. Nirogen; Nitrate as'N.
30: Nitrogen; Nitrite as N;
Nitrogen;Total, Kieldählas N:
32: Oil and Grease;
33 Phenoi›
34 Phosphorus: Total:as P:
.35.tPhosphorus: Ortho as:P
36:Sultätes
37. Surfactants)
38ALV254j
8326
39. Aluminum
,Antimony,
41: Arsenic
Barium
Beryllium
Boron
45. Cadmium
46. Caicium, as Caco,
47Calcium, Ca!
48.
_Chromium, Total:
49
Chromium: Hexavalent;
(50. Qobäht)
51: Copper™
52:Non)
53 Leadke
Mägnesium;
vanganese
6AMercury
Molybdenum
583N
fickels
59. Potassium
.60. Șelenium
61. Silver
62. Sodium.
"lyc
(63.Thallium
64: Vanadium
65: Zinc..
ICLPL
i66. Metälš/CN
: 67:Volatiles
:68. Semi volatiles
69."Pestičides/PCB's
7O Disk Deliverables
FTCLPT
TZIC Metals
72. TCLP-Pésticides
73 TCLP Herbicides:
TÄLTCLP Volátiles)
75 TCLPBNAS)
+92%
mitit
NYC-WTC
000071024
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