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
Time/Date Set:
Sample Type (circle one):
1)Potable
3. Non Potable Treated
2. Non Potable
4. Other
Time/Date Collected:
0830 10/17/01
Collected By:_ //1.NEWMAN Agency Code:
Collected From:
Location's/Individual's Name
NYCDEP/KENSZCO
Street 19WESTLK. DEIVE
City/St/Zip
VALHALLA, NY 10575
Identification of Source
Collection Point
CROG
NYS-ELAP No. 10198
Form A-70 (rev.1/9
ST8:245,035,72051925
4Fb-*715:HE
Bottle #'s:
Chain of Custody?yes
а по
Comments:
PWS #:
Source ID:_
Type Descriptor:
Bill to:
Name/Company
Street
City/St/Zip
Phone#:L
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. Colitorm P/A (public supplies)
3. Colfform MPN
(priv well, raw, stp)
4. Fecal Coliform (all samples)
5. Microscopic
6. Macroscopic
7. API
8. Other:
Refrigerated?
Chlorinated:?
yes
yes
Free Chlorine Res:
Total Chlorine Res:
nO
- пО
mg/L
mg/L
pH
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/Chiorte
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
13. Solids, Percent (%)
32. Oil an Grease
14. Solids, Settleable
33. Pnenol
15. Solids, Suspended
34. Phosphorus Total as P
16. Solids, Total
35. Phosphorus, Ortho as P
17. Solids, Total Dissolved
36. Sultates
18, Solids, Total Volatile
37. Surfactants
19. Other:
38. UV254
Lab#:
(circle tests)
Trihalomethanes (524)
2. Volatile Halocarbons (524)
Volatile Aromatics (524)
4. Vlotal Trhalomethane Potential (510)
Microextractables (504)
6.
Pesticides (507)
Pesticides/PCB screen (508)
8.
PCB as Decachlorobiphenyl (508A)
9
Herbicides (515)
Pesticides (525
11. Carbamate Pesticides (531)
12. Giyphosate (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:
25495
39
Aluminum
.40, Antimony
41. Arsenic
42. Barium
43) Beryllium
44. B0ron
45. Cadmium
46. Calcium, as CaCO3
47.Calcium, Ca*2
48. Chromium, Total
49. Chromium, Hexavalent
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)
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:
54 Magnesium
55 Manganese
56. Mercury
57 Molybdenum
58. Nickel
S
59. Potassium
60. Selenium
61 Siver
62
Sodium
63. Thailium
64
Vanadium
65. ZInc
CLP
66. Metals/CN
67Volatiles
68. Semi-violatiles
69. Pesticides/PCB's
70. Disk Deliverables
TCLP
71.TCLP-Metals
72. TCLP-Pesticides
73, TCLP Herbicides
74.TCLP-Volatiles
75. TCLR BNAS
NYC-WTC_000072332
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