NYC 9/11 Public Portal Document
Westchester
gov.com
ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM
WESTCHESTER COUNTY LABORATORIES AND RESEARCH
2 Dana Road, Valhalla, New York 10595
(914) 593-5575
Qse
me/Date Set:
NYS-ELAP No. 10108
Form A-70 (rev. 1/96)
Sample Type (circle one):
1. Potable
3. Non Potable Treated
2. Non Potable
4. Other
Time/Date Collectedi
1245
Collected By: h
Agency Codem
Collected From:
Location's/Individuals Name -Ny5
Street
R
City/St/Zip
леяs
Identification of Source
Collection Point eQu CH
G.
Bottle #834171
17807174,1142,319
Chain of Gustody72ese0s1337
Comments:
PWS #:
Source ID:
Type Descriptor:
Bill to:
Name/Company
Street
City/St/zip
Phone#:
Fax#:
CA,CH, BI?
Check#:
Amounts
BACTERIOLOGICAL ANALYSIS
ORGANIC POTABLE ANALYSIS
ORGANIC NONPOTABLE/SOLID ANALYSIS
Lab#
(circle tests)
1. Heterotrophic Plate
Count (hemodialysis & all others)
2. Collform P/A (public supplies)
3. Coliform MPNF (priv well, raw, stp)
Fecal Coliform (all samples)
Vicroscopic
Macroscopic
API
8. Other:
Refrigerated?
Lyes
Chlorinated:? yes
Free Chlorine Res:
Total Chlorine Res:
mg/L
mg/L
рH
Lab#:
(circle tests)
Ao Trihalomethanes (524)
2yvolatile Halocarbons(524)
Volatile Aromatics (524)
4.
Total Trihalomethane Potential (510)
5. Microextractables (504)
Pesticides (507)
Pesticides/PCB screen (508)
8. PCB as Decachlorobiphenyl (508A)
teroicides (515)
410.
Pesticides (525)
11. 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:
1. Purgeable Halocarbons (624/8260)
2. PurgeableAromatics (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. Herbicides (EPA1978/8151)
9. Pesticides (SM18/6630)(
10. Petroleum Hydrocarbon Scan (310-13)
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)
18. Other:
INORGANIC ANALYSIS REQUESTED - Lab#:
circle tests)
1. Color
20. Acidity
39. Aluminum
munh
2. Turbidity
21. Alkalinity, as CaCOs
40, Antimony
3. рн
22. Bromide
41. Arsenic
4
Conductivity
23. Bromate/Chlorate/Chlorite
42. Barium
5. Corrosivity (temp:
°C)
24. Chloride
43.Beryllium
6. BOD (5 day)
25. Cyanide
-44. Boron
7. Soluble BOD (5 day)
26. Fluoride
45. Cadmium
8.
Carbonaceous BOD (5 day)
27. Hardness, Total as CaCO3
46. Calcium, as CaCOs
9. Chemical Oxygen Demand
28. Nitrogen, Ammonia as N
47)Calcium, Ca+2
10. Dissolved Oxygen
29. Nitrogen, Nitrate as N
48. Chromium, Total
11. Total Organic Carbon
30. Nitrogen, Nitrite as N
49. Chromium, Hexavalent
2. Totai Organic Halides
31. Nitrogen, Total Kjeldahl as N
50.Cobalt
Solids, Percent (%)
32. Oil an Grease
51.Copper
Solids, Settleable
33. Phenol
5. Solids, Suspended
34. Phosphorus Total as P
16. Solids, Total
35. Phosphorus, Ortho as P
17. Solids, Total Dissolved
36. Sulfates
18. Solids, Total Volatile
37Surfactants
19, Other:
38.UV254
53.Lead
54 Magnesium
55 Manganese
56. Mercury
57, Molybdenum
58. Nickel
(59, Potassium
60. Selenium
61. Silver,
62. Sodium
63. Thallium
64) Vanadium
DBy
65. Zinc
CLP
66. Metals/CN
67. Volatiles
68. Semi-violatiles
69. Pesticides/PCB's
70. Disk Deliverables
TCLP
71.TCLP-Metals
72,TCLP-Pesticides
73, TCLP-Herbicides
74. TCLP-Volatiles
75.TCLP-BNAS
NYC-WTC_000071994
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