NYC 9/11 Public Portal Document
Westchester
govcon
ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM
WESTCHESTER COUNTY LABORATORIES AND RESEARCH
2 Dana Road, Valhalla, New York 10595
(914) 593-5575
e/Date Set:
Sample Type (circle one):
1Potable
3. Non Potable Treated
2. Non Potable
4. Other
Time/Date Collected:
0920
10-16-01
Collected By: _
M.NEWMAN Agency Code:
Collected From:
Locations/Individuats Name NYCDEP / KENSICO
19VALTLK: DRIVE
City/St/Zip
VALHALLA, N4
10095
Identification of Source
Collection Point
CRO GH/
NYS-ELAP No. 10108
Form A-70 (rev.1/96
ф:8i94a18,7
21569:50
Bottle #'s:
Chain of Custody?
yes
•no
Comments:
PWS #:_
Source ID:
Type Descriptor:
Bill to:
Name/Company
Street
City/St/Zip
Phone#:
Fax#:
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
Macroscopic
8. Other:
Refrigerated?
Chlorinated:?
Free Chlorine Res:
yes
uyes
no
Total Chlorine Res:
mg/L
_mg/L
pH
LabE
(circle tests)
1. Trihalomethanes (524)
2. Volatile Halocarbons (524)
VolatileAromatics (524)
4.
Total Trihalomethane Potential (510)
Microextractables (504)
Pesticides (507)
Pesticides/PCB screen (508)
9.
PCB as Decachlorobiphenyl (508A)
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:
INORGANIC ANALYSIS REQUESTED - Lab#:
(circle tests)
1. Color
20. Acidity
2. Turbidity
21. Alkalinity, as CaCO3
3. рH
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
13. Solids, Percent (%)
32. Oil an Grease
Solids, Settleable
33. Phenol
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: Sn,
38. UV254
25377
39, Aluminum
40. Antimony
41. Arsenic
42, Barium
43/Beryllium
*44. Boron
45. Cadmium
46. Calcium, as CaCOs
47. Calcium, Ca*
48. Chromium, Total
49. Chromium, Hexavalent
50,Cobalt
51.Copper
52. Iron
53.Lead
54 Magnesium
55 Manganese
56. Mercury
5x 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)
GC/MS Semivolatile Unknown Scan
15. Purgeable Halocarbons (DEF)
16. Purgeable Aromatics (DEF)
17. Pesticides/PCB's (DEF)
18. Other:
moblo
59. Potassium
BY
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. TCLP-Pesticides
73. TCLP-Herbicides
74. TCLP-Volatiles
75. TCLPBNA'S
NYC-WTC_000072423
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