NYC 9/11 Public Portal Document
Westchester:
gov.com
ENVIRONMENTAL SERVICES SÄMPLE SUBMISSION FÖRM
WESTCHESTER COUNTY LABORATORIES AND RESEARCH;
2 Dana Road, Valhalla, New York 10595-
(914) 593-5575-
e/Date Set:
Sample Type (circle one):
C. Potable
3. Non Potable Treated
2. Non Potable
4. Other
Time/Date Collected: 10:25-01 0945
Collected By: D. 5 COTT
Agency Code:
Collected From:
Location's/Individual's Name NYC - DEP
Street_
19 WEST LAKE DRIVE
City/St/Zip
VALHALLA NY 10595
Identification of Source
Collection Point Cra Got
NYS-ELAP,No: 10108
Form A-70 (rev.1/96):
Q Z10z
@2103;QFB 21B
Bottle #s: _
C.4845: P2009, P2013 PFB 2039
Chain of Custody?
- yes'_no
<8485, k8487
comments:
58484
PWS #:
Source ID:
Type Descriptor:
Bill to:
Name/Company
Street
City/St/Zip
Phone#:
Fax#:
CA,CH, BI?
Check#:
_ Amounts
BACTERIOLOGICAL ANALYSIŞ
Lab#:
.(circle tests)
1: Heterotrophic:Plate
Count (hemodialysis & all others)
2. Colitorm P/A, (public supplies)
3. Coliform MPN
(priv well, raw, stp)
4: Fecal Coliform] (all samples).
5: Microscopic
acroscopic:
8! Other:
Refrigerated?
Chlorinated:?
Free Chiorine Res:
Total Chlorine Res:
_ yes =
_no
yeş
•nO
_mg/L
mg/L
pH:
ORGANIÇ POTABLE ANALYSIS
Lab# a
(circle tests)
1.- Trihalomethanes (524)
2: Volatile Halocarbons.: (524)
3/ Volatile Aromatics. (524),
4. Total Trihalomethane Potential: (510)
• 5.; Microextractables (504)*
6. Pesticides: (507).
,Pesticides/PCB screen (508)
8.LPCB aś Decachlörobipheny! (508A);
9. Herbicides (515),.
10,- Pesticides, (5,25)
1f. Carbamate Pesticides (531)
12. Glyphosate (547)
13. Diquat (549)
14. Chlorination Disinfection Byproducts (551)
15. Haloacetic Acids (552)•
16: Pesticides (SM18/6630)
17. Petroleum/Hydrocarbon Scan (310-13)*
18. Other:
ORGANIC NONPOTABLE/SOLID ANALYSIS
1. Purgeable Halocarbons (624/8260)
2. Purgeable Aromatics (624/8260)
3..Acrolein & Acrylonitrile (624).
. : 41Phthalatés (625/8270)
waar
5. Organochlorine Pesticides: (608/8081) 3,
6. PCB's (Arochlors). (608/8081)
7. Méthoprene (616) :
8. Herbicides (EPA1978/8151)
9. Pesticides: (SM18/6630)*
10: Petroleum Hydrocarbon Scan (310-13)2
11. Glycols
12. Acid Extractables; (625/8270) :
13. Base Neutral Extractables: (625/8270)
14 GC/MS"Semivolatile Unknown Scan'
15 Purgeable Halocarbons *(DEF)
16. Purgeable Aromatics (DEF)
17. Pesticides/PCB's; (DEF)
70
§atate.
18.Other:
INORGANIC ANALYSIS REQUESTED- Lab#
(circle tests):
1. Color
20. Acidity
→21. Alkalinity, as CaCO3.
22. Bromide
4.
.Çonductivity,
23. Bromate/Chlorate/Chlorite
6.
Corrosivityr(temp:
°C)
24. Chloride
BQD (5 day),
25: Cyanide.
Soluble BOD (5 day):
26. Fluoride
8.
Càrbonaceous BOD_ (5 day),
27: Hardness": Total as CaCOs)
9.% Chemical Oxygen Demand,
28. Nitrogen; Ammonia asN
‹10. Dissolved Oxygen
29. Nitrogen, Nitrate as N'
1gTotãi Organic Cârbon
"301Nitrogen;, Nitrite as N;
12. Total Organic Halides
31: Nitrögen;Total Kjeldahl as N:
c: Solids, Percent? (%):
32 Oil'an Grease
Solids, Settleableł
33?Phenol
Solids, Suspended
34.Phosphorus Total as P'
16. Solids,Totai)
35 Phosphorus: Orthoas P:
17: Solids, Total Dissolved.
36: Sulfates
18: Solids. Totái Volatilè:
37 Surtactants
other:
Sni
38UV254}
153
39. Aluminum
40. Anțimony
41. Arsenic.
42. Barium
43.Beryllium
44. Boron
45. Cadmium
46. Calcium, as СaCOз
47. Calcium, Cat2..
48:Chromium, Total!
49: Chromium, Hexavälent:
30.Cobalt!
51!Copper
Đron
3:Leãd)
)Magnesium:
Manganese:
56! Mercury
57 Moiybdenum:
58 Nickel]
mekes:
9. Potaşsium
/60. Selenium
61. Silver
62: Sodium
53:Thallium.
tyanadium
65
Zinc
CLP
66. Metals/CN
67 Volatiles
¡68: Semi-violatiles
69. Pesticides/PCB's
'70.Disk Deliverables
TCLP
7i TCLP-Metäls.
72 TCLP-Pesticides,
73 TCLP-Herbicides)
}74ÎCLR:Volàtileşž
{75 TCLP BNA'S;
NYC-WTC_000071797
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