NYC 9/11 Public Portal Document
Westchester
gov.com
ENVIRONMENTALSERVICES SAMPLESUBMISSIONFORM
WESTCHESTER COUNTY LABORATORIES AND RESEARCH
2 Dana Road, Valhalla, New York 10595
(914) 593-5575
Time/Date Set:
Sample Type (circle one):
(L.Potable
3. Non Potable Treated
2. Non Potable
4. Other
Time/Date Collected: 074 C
Collected By: L
16.07-01
Agency Code:
Collected From:
Location's/Individual's Name_ NVC. Drp
Street
1C1
Mestiake
City/St/Zip
Veihallo
11/1059)
Identification of Source
Collection Point
Lcl
NYS-ELAP No. 10108
Form A-70 (rev.1/96)
C-041/
ТУ0T,1н, 127
Bottle #s: Q285
158387
K 020y <v2
Chain of Custody?
-yes-
8863
Comments:
PWS #:_
Source ID:
Type Descriptor:
Bill to:
Name/Company
Street
City/St/Zip
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)
Fecal Coliform (all samples)
Microscopic
o. Macroscopic
7. API
8. Other:
Refrigerated?
Chlorinated: ?
Free Chlorine Res:
- yes
yes
-no
mg/L
mg/L
Total Chlorine Res:
pH
Lab#:
(circle tests)
1. Trihalomethanes (524)
2. Volatile Halocarbons (524)
Volatile Aromatics (524)
Total Trihalomethane Potential (510)
5. Microextractables (504)
co
Pesticides (507)
Pesticides/PCB screen (508)
8.
PCB as Decachlorobiphenyl (508A)
9
Herbicides (515)
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:
INORGANIC ANALYSIS REQUESTED - Lab#:
(circle tests)
1. Color
20. Acidity
2. Turbidity
21. Alkalinity, as CaCO3
3. pH
22. Bromide
4. Conductivity
23. Bromate/Chlorate/Chlorite
5. Corrosivity (temp:
°C)
24. Chloride
6. BOD (5 day)
25. Cyanide
7. Soluble BOD (5 day)
26. Fluoride
8. Carbonaceous BOD (5 day)
27. Hardness, Total as CaCO3
9. Chemical Oxygen Demand
28. Nitrogen, Ammonia as N
10. Dissolved Oxygen
29. Nitrogen, Nitrate as N
11. Total Organic Carbon
30. Nitrogen, Nitrite as N
12. Total Organic Halides
31. Nitrogen, Total Kjeldahl as N
3. Solids, Percent (%)
32. Oil an Grease
14. Solids, Settleable
33. Phenol
15. 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
37. Surfactants
19. Other:
38. UV254
6470
39. Aluminum
(40. Antimony
41. Arsenic
42. Barium
43 Beryllium
44. Boron
45. Cadmium
46. Calcium, as CaCO3
(47 Caicium, Ca+2
48. Chromium, Total
49. Chromium, Hexavalent
u.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. 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)
(4GC/MS Semivolatile Unknown Scan
15. Purgeable Halocarbons (DEF)
16. Purgeable Aromatics (DEF)
17. Pesticides/PCB's (DEF)
18. Other:
Meta
59,Potassium
60. Selenjum
61. Silver
62. Sodium
(63./Thallium
64. Vanadlun
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_000071998
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