NYC 9/11 Public Portal Document
235977727
ENVIRÖNMENTAL SERVICES SAMPLE SUBMISSION FORM
WESTCHESTER COUNTY LABORATORIES AND RESEARCH.
2 Dana Road, Valhälla; New. York,10595 ;
.(914) 593-5575
NYS-ELAP, No. 10108
me/Date Set:
Samplę Type (circlo one):
Potable"
: 3. Non Potable Tréated
2 Non-Potable
4. Other,
Time/Date Collected: 915
tia?lrfs
Collecied By: :NE:VMN
Agency Code:
Collected From:
Location's/Individual's Name:
NYCDEP /KENSiO
Street
VVNESTLL
DRIVE
City/SVZip=
VALHAUA N!M
Identification of Source
Collection Point :
CROGH/
Form A-70 (rev.:1/96)1
6-2015)
02763005324949,
Bottle #'s:
440g8-10j400
Chain of Custody? !
_yes_
no
"Comments:
PWS #:_
Source ID:_
_Type Descriptor:
• Bill to:
Name/Company
10575
Street
City/St/Zip
Phone#:
Fax #:
CA, CH, BI?
Check#:
Amount$
BACTERIOLOGICAL ANALYSES
Lab#:
(circlè tests)
1.Heterotrophic Plate
Count (hemodialysis & all others)
2. Coliform P/A:(public supplies)::
3: Coliform MPN (priv well, raw; stp)
4. Fecal Colitorm (all bamples)
:5. Microscopic
•6: Macroscopic
ther:.
Refrigerated?*2A
_yes
Chiörnấted?:
-yes
Free Chiorine Res:
Total Chlorine Res:
pH
no
no
mg/L
mg/L
ORGANIC POTABLE ANALYSES
Lab #:
• (circle tesls)
1 Trihalomethanes (524)
• Volatile Halöcarbons (524)
Volatile Aromatics (524)
.Total Trihalomethane Potential (510)
•Microextractablés (504)
Pesticides (507),-
Pesticides/PCB screen (508)
8
PCB as Decachlorobiphenyl (508A)•
Herbicides (515):
C Pesicides (525)
Carbämate Pešticides (531)
12: Glyphosate (547).
*13 Diquat (549)
i4. Chlorination Disinfection Byproducts (551)
15. Haloacetic: Acids (552)
:16. Other Pesticides (SM-18/6630)
17: PetroleumHydrocarbon Scan (310-13)
ORGANIC NONPOTĄBLE/SOLID ANALYSES
1. Purgeable Halocarbons (624)8260). *
2..
Purgeable Arömatics (624/8260)
3.
Acrolein & Acrylonitrile (624)
4._Phthalàtes (606/8060)
5.
Organöchiorine: Pesticides. (608/808Ö),
."PCB's (Aröchiors) (608/8080)
7: Herbicides (SM-18/6640, 8151);
8: Other.Pesticides (SM-18/6630).
9. Pètroteum Hydrocarbon Scan (310-13)'
11. Acid Extractablès (625)8270)*
12 Base Neutral Extractables (625/8270)
3)GC/MS Unknown Scan,
14. Purgeable Hàlocarbons (DEF)*
15: Purgeable Aromätics (DEF)
16: Pésțicides (DĘF)I
•17. PCB's (Arochlors) (DEF)
1217
KINORGANIC ANALYSES REQUESTED,-Lab#:_
=riipi.
(circle tests)
20. Acidity:
39. Aluminum
Turbidit
,21. Alkalinity, as CaCO3:
(40 Antimony
22 Bromide
41. Arsenic
Conductivity,
5
Corrosivity (temp
6.
BOD, (5 day)
:7
Soluble BOD (5,day)
Carbonaçeous BOD (5 day)
9
Chemical Oxygen Demand
10. Dissolved Oxygen:
11. Total Organic Carbon!
12: Total Organic Halides;
Solids, Percent (%);
Söliďš: Sëftleablễ
¿Solids. Suspended:
•16!Solids; Total!
*17! Solids, Total Dissolved)r
₺18) Solids: Toral Volatile)
Mö Otherjad Sngl.1
sinh;
NYC-WTC_000072229
+23~BromateLChlorate/Chlorite
42 Barium
24. Chloride
43.-Beryllium
25. Cyanide
44: Boron.
: 26. Fluoride
45. Cadmium
27.Hardness, Total as CaCO3:
46- Calcium, as CaCO3
: 28.:Nitrogen: Ammonia as N.
Calcium Ca+?
29 Nitiogen, Nitrate as N
48. Chromium, Total
30' Nitrogen, Nitrite as N.
31. Nitrogen, Totäl Kjeldähtas N;
59 Coantym: Hoxavalent
32.Oil and Grease:
51! Copper:
33 Phenol'
52Hron
34! Phosphorus. Total as:P
53!Lead!
354Phosphorus, Orthö asiP:
54>Magnesium:
36: Sulfates:
155. Manganese'
37! Surtäctants)
56: Mercuryt:
38rLIV254}
‚57, Mölybdenum:
58*Nickelz
mexaso
:Potassium
60. Seleniùr
61÷Șilvert
62. Sodium.
63. Fhalijur
64,/Vanadium,
.65.Zinc :
CLP,
[66.Metals/CN:
¿67. Volatiles
68. Semi volatiles
69x Pesticides/PCBs)
17O: Disk Delivorablos
TCLP*
71. TCLP:Metals)
(72} TCLP-Pesticides)
17,3: TCLP-Herbicides,
74 LCL2:olatiless.
75:TCLP-BNA'S)
steneon
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