NYC 9/11 Public Portal Document
vasrchestel
OVC009
ENV FONMENTAL SERVICES SAMPLE SUBMISSION FORM
WESTCHESTER COUNTY LABORATORIES AND RESEARCH
ADana Road, Valhalla, New York 10595
(914) 593-5575
umerpate Set
Sampieptype ardelone
1.Potabie
E.Non Potable reated
2. Non Potable
4. Other
Time/Date Collected:
Collected By:
2-27-01
Agency Code:
Collected From:
Location's/Individual's Name NYC DrP
Street 19 Wesilous DRiuc
City/St/Zip
Valhalla, Ny 10595
Identification of Source
Collection Point_De 116
NYS-ELAP No. 10108
Form A-70 (rev.1/96)
Botle +s: C0440PFB185,12242K
Chain of Custody? - yes
•2 3not
б5-
Comments:
PWS #: _
Source ID:
.Type Descriptor:
Bill to:
Name/Company
Street
City/StZip
Phone#:
Fax#:
CA,CH, BI?
Check#:
Amount$
BACTERIOLOGICAL ANALYSIS
ORGANIC POTABLE ANALYSIS
ORGANIC NONPOTABLE/SOLID ANALYSIS
Lab#
(circle 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)
Microscopic
Macroscopic
.API
8. Otner:
Refrigerated?
Chlorinated:?
ves
yes
Free Chlorine Res:
Total Chlorine Res:
mg/L
mg/L
рH
Lab#:
(circle tests)
1. Trihalomethanes (524)
2.) Volatile Halocarbons (524)
/ Volatile Aromatics (524)
4.
Total Trihalomethane Potential (510)
5
Microextractables (504)
6.
Pesticides (507)
Pesticides/PCB screen (508)
PCB as Decachlorobiphenyl (508A)
Herbicides (515)
Pesticides (525)
fi carbamaso Pestcdes (S3)
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.
INORGANIC ANALYSIS REQUESTED - Lab#:
(circle tests)
1. Color
2. Turbidity
3. pH
4. Conductivity
5. Corrosivity(temp:
°C
6. BOD (5 day)
7. Soluble BOD (5 day)
8. Carbonaceous BOD (5 day)
9. Chemical Oxygen Demand
10. Dissolved Oxygen
11. Total Organic Carbon
12. Total Organic Halides
Solids, Percent (%)
Solids, Settleable
15. Solids, Suspended
16. Solids, Total
17. Solids, Total Dissolved
18. Solids, Total Volatile
19. Other:
20. Acidity
21. Alkalinity, as CaCO3
22. Bromide
23. Bromate/Chlorate/Chlorite
24. Chloride
25. Cyanide
26. Fluoride
27. Hardness, Total as CaCO3
28. Nitrogen, Ammonia as N
29. Nitrogen, Nitrate as N
30. Nitrogen, Nitrite as N
31. Nitrogen, Total Kjeldahl as N
32. Oil an Grease
33. Phenol
34. Phosphorus Total as P
35. Phosphorus, Ortho as P
36. Sulfates
37 Surtactants
38. UV254
39. Aluminum
(40? Antimony
41. Arsenic
42. Barium
(43)Beryllium
44. Boron
45. Cadmium
46. Calcium, as CaCOs
47)Calcium, Cat2
48. Chromium, Total
49, Cnromium, Hexavalent
50/Cobalt
51. Copper
52 Iron
53.Lead
54, Magnesium
55 Manganese
56. Mercury
57 Molybdenum
58. Nickel
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. Metheprene (616)
8. Herbicides (EPA1978/8151)
9. PesticidesSM18/6630)
10. Petroleum HydrocarbonScan (310-13)
11. Glycols
12. Acid Extractables(625/8270)
Base NeutralExtractables(625/8270)
14. GC/MS Semivolatile Unknown Scan
15. Purgeable Halocarbons (DEF)
16. Purgeable Aromatics (DEF)
17. Pesticides/PCB's (DEF)
18. Other:
Metus
59) Potasşium
60. Selenium
61. Silver
62, Sodium
63Thailium
(64) Vanadium
65. Zinc
CLP
66, Metals/CN
67. Volatiles
68. Semi-violatiles
69. Pesticides/PCBs
70. Disk Deliverables
TCLP
71.TCLP-Metals
72. TCLP-Pesticides
73. TCLP-Herbicides
74, TCLP-Volatiles
75.TCLP-BNA'S
NYC-WTC_000071996
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