NYC 9/11 Public Portal Document
ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM
WESTCHESTER COUNTY LABORATORIES AND RESEARCH
2 Dana Road, Valhalla, New York 10595
chester County
(914) 593-5575
NYS-ELAP No. 10108
ime/Bate Set:
Form A-70 (rev. 1/96)
Sample Type (circle one):
1-26 2030 2526 0027, 0+04251
Potable
3. Non-Potable Treated
Bottle #sQF620, C--415,
be sonc, 7u0), тo.
2.- Non-Potable
4. Other.
Chain of Custody?
Eyes
Time/Date Collected:
ORYO
10/55/61
Comments:
Collected By: MA
Afrroad Agency Code:
PWS #:
Source ID:
Type Descriptor:
Collected From:
Location's/Individual's Name_
NYCDFP/EINSICO Name/Company
Street
o пiрet (
Dice
City/St/Zip
Vatilnlla
10595
City/St/Zip
Identification of Source
Phone#:
Fax #:
Collection Point
20/,8
CA, CH. BI?
Check#:
Amount$
BACTERIOLOGICAL ANALYSES
ORGANIC POTABLE ANALYSES
ORGANIC NONPOTABLE/SOLID ANALYSES
Lab#:
(circle lests)
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
Macroscopic
AP:
Other:
Refrigerated?
yes
no
Chlorinated?:
Lyes
no
Free Chiorine Res:
Total Chlorine Res:
_mg/L
Lab #:
(circle tests)
Trihalomethanes (524)
Volatile Halocarbons (524)
Volatile Aromatics (524)
4
5.
6
Total Trihalomethane Potential (510)
Microextractables (504)
Pesticides (507)
Pesticides/PCB screen (508)
PCB as Decachlorobiphenyl (508A)
9
Herbicides (515)
Pesticides (525)
Carbamate Pesticides (531)
12. Glyphosate (547)
13. Diquat (549)
14. Chlorination Disinfection Byproducts (551)
15. Haloacetic Acids (552)
16. Other Pesticides (SM-18/6630)
17. Petroleum/Hydrocarbon Scan (310-13)
1.
Purgeable Halocarbons (624/8260)
2.
PurgeableAromatics (624/8260)
3
Acrolein & Acrylonitrile (624)
4.
Phthalates (606/8060)
5.
Organochlorine Pesticides (608/8080)
PCB's (Arochlors) (608/8080)
7.
Herbicides (SM-18/6640; 8151)
8. Other Pesticides (SM-18/6630)
9. Petroleum Hydrocarbon Scan (310-13)
10. Glycols in Water
11. Acid Extractables (625/8270)
12. Base Neutral Extractables (625/8270)
(3. GC/MS Unknown Scan
14. Purgeable Halocarbons (DEF)
15. Purgeable Aromatics (DEF)
16. Pesticides (DEF)
17. PCB's (Arochlors) (DEF)
pH
INORGANIC ANALYSES REQUESTED - Lab#:
(circle tests)
1.
2
3.
Color
Turbidity
рH
Conductivity
Corrosivity (temp:_
°C)
6
BOD (5 day)
Soluble BOD (5 day)
8.
Carbonaceous BOD (5 day)
9.
Chemical Oxygen Demand
10. Dissolved Oxygen
11. Total Organic Carbon
9. Total Organic Halides
Solids, Percent (%)
14. Solids. Settleable
5. Solids, Suspended
16. Solids, Total
17. Solids, Total Dissolved
18. Solids, Total Volatile
9. Other:
Sn
)1474
Putdo
BY
34
20. Acidity
21. Alkalinity, as CaCO3
22. Bromide
23. Bromate/Chlorate/Chlorite
24. Chloride
25. Cyanide
26. Fluoride
27. Hardness, Total as CaCO,
28. Nitrogen, Ammonia as N
29. Nitrogen, Nitrate as N
30. Nitrogen, Nitrite as N
31. Nitrogen, Total Kjeldahl as N
32. Oil and Grease
33. Phenol
34. Phosphorus, Total as P
35. Phosphorus, Ortho as P
36. Sulfates
37. Surtactants
38JV254
39. Aluminum
40. Antimony
41. Arsenic
42. Barium
43. Beryllium
44. Boron
45. Cadmium
46. Calcium, as CaCOs
47. Calcium, Ca*2
48. Chromium, Total
49. Chromium, Hexavalent
50) Cobalt
51. Copper
52,lron
53. Lead
54. Magnesium
55. Manganese
56. Mercury
57, Molybdenum
58. Nickel
59 Potassium
60. Selenium
61. Siver
62. Sodium
63. Thallium
64. Vanadium
65. Linc
CLP
66. Metals/CN
67. Volatiles
68. Semi-volatiles
69. Pesticides/PCB's
70. Disk Deliverables
UCLP
71. TCLP-Metals
72, TCLP-Pesticides
73. TCLP-Herbicides
74. TCLP-Volatiles
75, TCLP-BNA'S
NYC-WTC_000072023
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