NYC 9/11 Public Portal Document
AWestchester
pov.com
ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM
WESTCHESTER COUNTY LABORATORIES AND RESEARCH
2 Dana Road, Valhalla, New York 10595
(914) 593-5575
e/Date Set:
NYS-ELAP No. 10108
Form A-70 (rev.1/96,
Sample Type (circle one):
1. Potable
3. Non Potable Treated
2, Non Potable
4. Other
Time/Date Collected:
945
10/16/01
Collected BytMilC.0
Agency Code:
Collected From:
Location's/Individual's Name
DEP
Street
14 wer (Aié
Dr.
City/St/Zip
Valkallu Mg/0595
Identification of Source
Collection Point
(AT (1C
C-0274 K-8185,6493,8187
•Botle 757,9123,9119
P•157.1192
Chain of Custody?
- yes
_ по
Comments:
PWS#:
Source ID:
Bill to:
Name/Company
Street
City/St/Zip
Phone#: _
Fax#:
no k
Type Descriptor:
CA,CH, ВІ?
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)
5. Microscopic
acroscopic
8. Other:
Retrigerated?
Chlorinated:?
_ yes
no
Free Chlorine Res:
Total Chlorine Res:
yes _ no
_ mg/L
_mg/L
рH
Lab#:
(circle tests)
1.Trihalomethanes(524)
2. Volatile Halocarbons (524)
3 Volatile Aromatics (524)
4. Total Trihalomethane Potential (510)
5.
Microextractables (504)
6.
Pesticides (507)
Pesticides/PCB screen (508)
8. 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. Pesticides (SM18/6630)
17. Petroleum/Hydrocarbon Scan (310-13)
18. Other:
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)
GC/MS Semivolatile Unknown Scan
15. Purgeable Halocarbons (DEF)
16. Purgeable Aromatics (DEF)
17. Pesticides/PCB's (DEF)
18. Other:
INORGANIC ANALYSIS REQUESTED - Lab#:
(circle tests)
375
Metals
1. Color
20. Acidity
39. Aluminum
2. Turbidity
21. Alkalinity, as CaCO3
40, Antimony
3. рH
22. Bromide
41. Arsenic
4. Conductivity
23. Bromate/Chlorate/Chlorite
42. Barium
5. Corrosivity (temp:
°C)
24. Chloride
43 Beryllium
6. BOD (5 day)
25. Cyanide
44. Boron
7. Soluble BOD (5 day)
26. Fluoride
45. Cadmium
8. Carbonaceous BOD (5 day)
27. Hardness, Total as CaCO3
46. Calcium, as CaCO3
/9. Chemical Oxygen Demand
28. Nitrogen, Ammonia as N
47. Calcium, Ca+2
10. Dissolved Oxygen
29. Nitrogen, Nitrate as N
48. Chromium, Total
11., Total Organic Carbon
30. Nitrogen, Nitrite as N
49. Chromium, Hexavalent
12: Total Organic Halides
31. Nitrogen, Total Kjeldahl as N
50, Cobalt
13. Solids, Percent (%)
32. Oil an Grease
51.Copper
Solids, Settleable
33. Phenol
52. Iron
Solids, Suspended
34. Phosphorus Total as P
53.Lead
16. Solids, Total
35. Phosphorus, Ortho as P
54 Magnesium
17. Solids, Total Dissolved
36. Sulfates
55 Manganese
18. Solids, Total Volatile.
37. Surtactants
56. Mercury
19. Other:
38. UV254
57 Molybdenum*
58. Nickel
59. Potassium
60. Selenium
61. Silver
62. Sodium
63, Thallium
64
Vanadium
65. Zinc
CLP
66. Metals/CN
67. Volatiles
68. Semi-violatiles
69. Pesticides/PCB's
70. Disk Deliverables
TCLP
71 .TCLP-Metals
72.1CEP-Pesticides
73. TCLP-Herbicides
74. TCLP-Volatiles
75. TCLP-BNA'S
NYC-WTC_000072421
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