NYC 9/11 Public Portal Document
Westchester
aov.com
ENVIRONMENTA- SERVICES SAMPLE SUBMISSIONFORM
WESTCHESTER COUNTY LABORATORIES AND RESEARCH
2 Dana Road, Valhalla, New York 10595
(914) 593-5575
12:55
e/Date Set:
Sample Type (circle one):
1.Potable
3. Non Potable Treated
2. Non Potable
4. Other*
Time/Date Collected:
450
Collected By: -
D5
11-2-01
Agency Code:
Collected From:
Location's/Individual's Name_A-IC DEP
Street
19
WeST
LAKE DRIVE
City/St/Zip
Valhaclla, AN
10595
Identification of Source
Collection Point
CROGH
_NÝS-ELAP No. 10108
Form A-70 (rev.1/96)
Huk.
TuelA
445, ПУТ, C 0414
9.501210,9938,134
Bottle#s:P_ F13-2074 254274
Chain of Custody?
_ yes _no
Comments:
PWS #:.
Source ID: .
_Type Descriptor:
Bill to:
Name/Company
Street
City/St/Zip
Phone#:
Fax#:
CA,CH, BI?.
Check#:
Amount$
BACTERIOLOGICAL ANALYSIS
ORGANIC POTABLE ANALYSIS
ORGANIC NONPOTABLE/SOLID ANALYŞIS
Lab#:
(circle tests)
1. Heterotrophic Plate
Count (hemodialysis & all others)
2. Coliform P/A (public supplies) :
3. Coliform MPN (priv well, raw, stp)
4.Focal Coliform (all samples)
5. Microscopic
acroscopic
8. Other:
Refrigerated?
Chlorinated:?
Free Chlorine Res
Total Chlorine Res:
рH
yes
yes
no
no
mg/L
.mg/L
Lab#:
(circle tests)
1.
.Trihalomethanes (524)
Volatile Halocarbons (524)
Volatile Aromatics (524)
4. Total Trihalomethane Potential
(510)
5. Microextractables (504)
6. Pesticides (507)
C Pesticides/PCB screen (508)
8. PCB as Decachlorobiphenyl (508A)
9.Herbicides (515)
Pesticides (525)
Carbamate Peștiçides
(531)
12. Glyphosate (547)
:13. Diqyaty (549)
14. Chiorination Disinfection Byproducts
(551)
15. Haloacetic Acids (552)
16. Pesțicides (SM18/6630)
17. Petroleum/Hydrocarbon Scan (310-13)
18, Other::
1. Purgeable Halocarbons (624/8260)
2. Purgeable Aromatics (624/8260).
3. Acrolein & Acrylonitrile (624)
4.
. Phthalates (625/8270)
5.
Organochlorine Pesticides (608/8081)
6. PCB's (Arochlors) (608/8081).
7. Methoprene (616)
8
Herbictdes (EPA1978/8151)
9. Pesticides, (SM18/6630)
10. Petroleum Hydrocarbon Scan (310-13)
11, Giycols
12. Acla Extractables (625/8270)
Base Neutral Extractables (625/8270)
14 GC/MS Semivolatile Unknown Scan
15. Purgeable Halocarbons (DEF)
16. Purgeable Aromatics (DẸF)
17. Pesticides/PCB's (DEF)
18. Other:
INORGANIC ANALYSIS REQUESTED - Lab#
(circle tests)
1. Color a
20. Acidity
2. Turbidity
21. Alkalinity, as CaCO3
3. рh
22. Bromide
4. Conductivity
23. Bromate/Chlorate/Chlorite
5. Corrosivity (temp:
°C)
24. Chlorde
'6. BOD (5 day)
25. Cyanide
7. Soluble BOD (5 day)
26. Fluoride
8. Carbonaceous BOD (5 day)
27. Hardness, Total as CaCO3
9. Chemical Oxygen Demand
28. Nitrogön, Ammonia as N
10. Dissolved Oxygen
29. Nitrogen, Nitrate as N
MtsTotal Organic caroon
30. Nitrogen, Nitrite as N
12 Total Organic Halides
31. Nitrogen, Total Kjeldahl as N
16 Solids, Percent (%)
32. Oil an Grease
Solids, Settleable
33. Pheno
Solids, Suspended
34. Phosphorus Total as P
6 Solids, Total
35. Phosphorus, Ortho as P
Sollds, Total Dissolved
36. Sulfatos
Solids, Total Volatile
37, Surfactants
12)OtherSa,Ti
38: UV254*
39
Aluminum
JAntimony
41. Arsenic
42. Barium
43,Beryllium
44. Boron
45. Cadmium
46 Calcium, as CaCO3
Calcium, Ca*?
48.Chromium, Total
49
Chromium, Hexavalent
,Cobalt
51 Copper
32 lron
3.Lead
Magnestum
Manganese
56. Mercury:
57 Molybdenum
58. Nickel
59/Potassium
60. Selenium
•61. Silver:
Sodium
Thallium
Vanadium
65. Zinc
CLP
66. Metals/CN
67. Volatiles
68. Semi-violatiles.
69. Pesticides/PCB's
70 Disk Deliverables
TCLP
71.TCLP:Metals r
72. TOLP-Pesticides
73. TCLP:Herbicides
74 TCLP-Volatiles
75,TCLP BNAS
NYC-WTC_000071243
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