NYC 9/11 Public Portal Document
Wesrchester
rov.com
ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM
WESTCHESTER COUNTY LABORATORIES AND RESEARCH
2 Dana Road, Valhalla, New York10595
(914) 593-5575
Time/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:
Collected By: Wagner
/10.19.01
Agency Code:
Collected From:
Location's/Individual's Name NyC DEP
Street19 WosllaueDeule
Citystzip Valhalla Ny 10595
Identification of Source
Collection Point_CRO GH
QFB
1737440
93bo
0 7356
A-F6-9399
P-9393 P-9312
Bottle #s: (094)
и-таа н.4649
Chain of Custody?
yes
Comments:
PWS #
Source ID:
Type Descriptor:
Bill to:
Name/Company
Street
City/St/Zip
Phone#:
Fax#:
CA,CH, BI?
Check#:
Amount$
BACTERIOLOGICAL ANALYSIS
ORGANIC POTABLE ANALYSIS
ORGANIC NONPOTABLE/SOLIDANALYSIS
Labi:
(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
6. Macroscopic
ner
Refrigerated?
Chlorinated:?
Free Chlorine Res:
yes
yes
no
mg/L
mg/L
Total Chlorine Res:
pH S1
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)
7. Pesticides/PCB screen (508)
8. PCB as Decachlorobiphenyl (508A)
9. Herbicides (515)
10. Pesticides (525)
11. 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)
(14)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)
1. Color
2. Turbidity
3. рH
4. Conductivity
5. Corrosivity(temp:
6. BOD (5 day)
°C)
7. Soluble BOD (5 day)
8. Carbonaceous BOD (5 day)
*9. Chemical Oxygen Demand
10. Dissolved Oxygen
11.Total Organic Carbon
12. Total Organic Halides
13. Solids, Percent (%)
14. Solids, Settleable
Solids, Suspended
Solids, Total
17. Solids, Total Dissolved
18, Solids, Total Volatile
19. Otheri-SA,
nutars
20. Acidity
21. Alkalinity, as CaCO3
22. Bromide
23. Bromate/Chlorate/Chlorite
24. Chloride
25. Cyanide
26. Fluoride
27. Hardness, Total as CaCO3
28. Nitrogen, Ammonia as N
29. Nitrogen, Nitrate as N
30. Nitrogen, Nitrite as N
31. Nitrogen, Total Kjeldahl as N
32. Oil an Grease
33. Phenol
34. Phosphorus Total as P
35. Phosphorus, Ortho as P
36. Sulfates
37. Surfactants
38. UV254
39. Aluminum
O.Antimony
Arsenic
42. Barium
13. Beryllium
44. Boron
45. Cadmium
46. Calcium, as CaCO3
47.Calcium, Ca*2
48. Chromium, Total
49. Chromium, Hexavalent
50 Cobalt
1. Copper
52,Iron
53.Lead
54 Magnesium
155 Manganese
56. Mercury
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. TCLP-Pesticides
73. TCLP-Herbicides
74. TCLP-Volatiles
75. TCLP-BNA'S
NYC-WTC_000072662
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