NYC 9/11 Public Portal Document
IU.
ENVIRONMENȚAL SERVICES SAMPLE SUBMISSION FORM
WESTCHESTER COUNTY LABORATORIES AND RESEARCH
2 Dana Road, Valhalla, New York 10595'
Ichester County
(914), 593-5575
.NYS-ELAP No. 10108
-Time/Date Set:
GEBY310•31 0-414
Form A-70 (rev. 1/96)
Sample Type (circle one):
068:428 8-7590733
1 Potable
3. Non:Potable Treated
Botle #'sL 0500 KTB 0248.K.E75
K•EDErK-5
2 Non-Pötable™
4. Oiher =
Chain of Custody? .yes.no
Time/Date Collected:14: 3Q
M/o/c1
Collected By: Huindier
.і.-:
"Comments:_
Agency Code:
PWS #:
Source ID:
_Type Descriptor:
Collected From:
Bill to:
Location's/Individual's Name.
NyC DEP
Street 1 4
Wositake
Street
Cityisuzip_Valhalla
Dsivt
Name/Company-
NV 10573
City/SV/Zip.
Identification of Source.
Phone#:
Fax #:
Collection Point_
CRC ON
CA, CH, BI?
Check#:
Amounts
BACTERIOLOGICAL• ANALYSES
ORGANIC POTABLE ANALYSES
ORGANIC NONPOTABLE/SOLID ANALYSES
Lab#
(ciréle tests)
1. Heterotrophic Plate
Count (hemodialysis & all others)
2 Coliform P/A (public supplies)
3: Coliform MPN.(priv. well, raw, stp)
4: Fecal Coliform (all samples).
-5. Microscopic
6. Mäcroscopic
i
7. APi
:8.-Other:
¡Refrigerated?
Chiorinated?:
Free Chlorine Res:
TotalChlorine Res:
_yes_
•. nO
yes"
no
mg/L
mg/L.
•(circle lests)
Trihalomethanes (524)
3) Volatile Aromatico (524)
Volatile Halocarbons (524)
14
.5
Totạl Trihalomethane Potential (510)
Microextractäbles (504)
Pésticides (507)
Pesticides/PCB screen (508)
PCB äs Decachlorobiphenyl (508A).
Hérbicides (515).
10
Pesticides (525)
Carbamate P.esticides.(531)
12. Glyphosate (547):
3. Diquat (549)
14. Chlorination Disinfection" Byproducts (551)'
115. Haloacetic Äcids (552)
16. Other Pesticides (SM-18/6630)
417. Petroleum/Hydrocarbon Scan (310-13)
1. Purgeable Halocarbons (624/8260)
2. . Purgeable Aromatics (624/8260)
3. Acrolein & Acrylonitrile (624)
4.. Phthalates: (606/8060)
Organochlorine Pesticides (608/8080)
6:
PCB's (Arochlors) (608/8080)
Herbicides (SM-18/6640; 8151)
8: Other Pesticides (SM-18/6630)
9. Petroleum Hydrocärbon Scan (310-13)
10, Glycols, in Water:
11:Acid Extractables. (625/8270)
12 Bäse Nøuiral Exractables (62578270)
13) GC/MS Unkriown Scan
14. Purgeable Haloçarbons (DEF
15. Pürgeable Aromatićs (DEF)'
16. Pesticides (DEF)
17 PCB's (Árochlors) (DẸF)
Millio
INORGANIC ANALYSES REQUESTED gLab#
(circle tests)
Color
2: Turbidity
3.
4.
5.
6.
Conductivity
Corrosivity (temp:
BOD (5 day)
Soluble BOD (5 day)
8.: Carbonaceous BOD (5 day)
9.
Chemical Oxygen Demand
10: Dissolved Oxygen
11! Total Organic Carbon
12. Total Organic"Halides›
p13:Soldș; Percent (%):
{14. Solids, Settleable,
15: Solids, Suspended)
i6.
17g Solids) Total Dissolved]
18 Ohet:
: Solids Total,Volatile,
20. Acidity
, Alkalınny, as CaCO3
22. Bromide
°C)
+23-Bromate/Chlorate/Chlorite
*244 Choride
25Cyanide
26. Fluoride
27. Hardness, Total as. CaCO3,
28:Nitrogen, Ammonia as N:
29.1Nitrogen; Nitrate as N
3Ộ: Nitrogen: Nitrite as N°
31 Nitrogen, Total Kjeldahl as N)
32 Oiland Grease;
33 Phenol)
34 Phosphorus: Total as P!
35
Phosphorus; Ortho as P)
36: Sulfates]
'37 Surtactants,
3821
39. Aluminum:
40: Antimony
. Arsenic
42 Barium
43. Beryllium
.44. Boron,
45 Cădmium
46Calcium:as, CaC03.
A7/ Calcium, Ca*
484 Chromium, Total
49. Chromium, Hexavalenti
50) Cobalt:
Sft Copper?
lion>
Leadi
_Magnesium;
› Manganese
56!, Mercury,
k Mölyödenumì
60. Selenium
_61
Silver
Sodium
Thallium
Yinadium
Zinc.
CLP/
66 Metals/CN:
167-Volatiles;
:68. Semi-vólatiles
(69 Pesticides/PCB's,
S704Disk Delverables
ITCLP!
71! TCLP Mètals:
{72: TCLP Pesticides)
73:TCLP Hörbicides?
74:TCLP-Volatiles
75. TCLP BNA'S
NYC-WTC_000071480
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