NYC 9/11 Public Portal Document
ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM 56
WESTCHESTER COUNTY LABORAȚORIES AND RESEARCH
2 Dana Road, Valhalla, New York 10595
((914) 593-5575
Time/Date Se
Sample Type (circle one):
Potable
3. Non-Potablé Treated
2: Non-Potable:
4. Other
Time/Date Collected: 0905
la1l5.01
Collected By D: 3 Col Agency Code:
Collected From:
Locations/individuals Name_ NY C. DEP
Street
PWIeLt LAKE DRIVE
City/St/Zip
VACHALLA, NY. 10095
Identitication of Source
collection Point.5 CATLEFE
O 0Y
NYS-ELAP No. 10108
Form A-70 (rev: 1/96)
Botlo rs C.0464 6477,
5302/
ковоч косао
6382
2278
Chain of Custody?
K86331K vecuan
Comments:
BLANK
PWS #:
Source ID:
Type Descriptor:
Bill to:
Name/Company :
Street
City/St/Zip
Phone#:
Fax#:
CA, CH. ВІ?
Check#:
Amount$
BACTERIOLOGICAL ANALYSES
ORGANIC POTABLE ANALYSES
ORGANIC NONPOTABLE/SOLID ANALYSES
Lab#:
(circle tests)
1. Heterotrophic Plate
• Count (hemodialysis & all others)
2 Coliform PIA (public supplles).
3. Coliform MPN: (priv, well raw, stp)
4. Fecal Coliform (all samples)
5. Microscopic
6, Macroscopic
7.APF
8. Other.
Refrigerafed?
yes
• no
Chionnated?+yes
Free Chiorine Res:
no
mg/L
Total Chlorine Res:
mg/L
Lab #:
• (circle lests)
Trihalomethanes (524)
Volatile Halocarbons (524)
Volatile Aromatics (524)
Total Trihalomethane Potentíal (510)
Microextractables (504)
6.
Pesticides (507)2
Pesticides/PCB screen (508)
PCB as Decachlorobiphenyl (508A)
9:
Herbicides (515).
10 Pesticides (525)
11. Carbamate Pesticides (531)
12. Glyphosate (547)
13. Diquat (549) *
14. Chlorination Disinfection Byproducts (551)
15. Haloacetic Acids (552).
16. Other Pesticides (SM-18/6630)
17. Petroleum/Hydrocarbon Scan (310-13)
1. Purgeable Halocarbons (624/8260)
2. Purgeable:Aromatics (624/8260):
3.
Acrolein & Acrylonitrile (624)
4.
Phthalates (606/8060).
5.
Organochlorine Pesticides (608/8080)
6.
PCB's (Arochlors) (608/8080)
7.: Herbicides (SM-18/6640; 8151)
8. Other Pesticides (SM-18/6630)
9. Petroleum Hydrocarbon Scan (310-13)
10. Glycols in Water
11. Acid Extractables (625/8270)
KGCMS Unknown Scan
Base Neutral Extractables (625/8270)
14. Purgeable Halocarbons (DEF)
15: Purgeable Aromatics (DEF)
16. Pesticides (DEF)
17. PCB's (Arochlors) (DEF)
INORGANIC ANALYSES REQUESTED - Lab#:
(circle tests)
1: Color
2 Turbidity
3.
4:: Conductivity
5. Corrosivity (temp:
°C)
6.
.BOD (5 day)
7.
Soluble BOD (5 day).
:Carbonaceous BOD (5 day)
Chemical Oxygen Demand
10. Dissolved Oxygen:
11. Total Organic Carbon
12. Total Organic Halides
13. Solids, Percent (%)
14. Solids, Settleable
15. Solids; Suspended
16. Solids, Total:
17. Solids. Total Dissolved
1i Solids, Total Volatile
pther Sa
20. Acidity
21. Alkalinity, as CaCO3
22. Bromide
23. Bromate/Chlorate/Chlorite
24. Chloride
25. Cyanide
26. Fluoride-
27. Hardness, Total as ÇaCO3
28. Nitrogen, Ammonia as N
29: Nitrogen, Nitrate as N
30, Nitrogen, Nitrite as N
31. Nitrogen; Total Kjeldahl as N
32. Oil and Grease
33. Phenol
• 34. Phosphorus, Total as P
35: Phosphorus, Ortho as P
36. Sulfates
37. Surtactants
38. UV254
27118-
39. Aluminum
40. Antimony
41. Arsenic
42. Barium
43. Beryllium
44. Boron
45. Cadmium
46. Calcium, as CaCO3
A7-Calcium, Cat2
48. Chromium; Total:
49. Chromium, Hexavalent
(50 Cobalt:
51. Copper
52,/ron :
53. Lead :
54, Magnesium
55-Manganese
56. Mercury
$57
Molybdenum
158. NickelC31
meteto
59.Potassium
60. Selenium
61.Silver
{62 Sodium
_63-Thallium
64.Vanadium
65. Zinc
CLP
66. Metals/CN
67. Volatiles
68. Semi-volatiles
69. Pesticides/PCB's
70. Disk Deliverables
TCLP
71. TCLP-Metals
72. TCLP-Pesticides
73. TCLP-Herbicides
74. TCLP-Volatiles
75. TCLP-BNA'S
NYC-WTC_000071409
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