NYC 9/11 Public Portal Document
Westchester
gov.com
ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM
WESTCHESTER COUNTY LABORATORIESAND RESEARCH
2 Dana Road, Valhalla, New York 10595
(914) 593-5575
Time/Date Set:
NYS-ELAP No. 10109
Form A-70 (rev.1/9
Sample Type (circle one):
1.Potable
3. Non Potable Treated
2. Non Potable
4. Other
Time/Date Collected:
Collected By: Wogaer
до от
Agency Code: -
Collected From:
Location's/Individual's Name NyC DC P
Street 19 Wesilalc Demur
City/St/Zip
Valhalla NV 10s9s
Identification of Source
Collection Point
9423.
P: 365, P. 9700
CF8-109
0-128,0-209
Bottle #'s:
032 К-23. K-2319 и:0216
Chain of Custody? yes no
Comments:
PWS #:
Source ID:
Type Descriptor:
Bill to:
Name/Company
Street
City/St/Zip
Phone##:
Fax#:
CA,CH, BІ?
Check#:
Amount$_
BACTERIOLOGICAL ANALYSIS
ORGANIC POTABLEANALYSIS
ORGANIC NONPOTABLE/SOLID ANALYSIS
Lab#:
(circle tests)
1. Heterotrophic Plate
Count (hemodialysis & all others)
2. Coliform P/4 (public supplies)
3. Coliform MPN (priv well, raw, stp)
4. Fecal Coliform (all samples)
5. Microscopic
6. Macroscopic
7. APl
8. Other:
Refrigerated?
Chlorinated:?
yes
yes
Free Chlorine Res.
Total Chlorine Res:
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)
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
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
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. Phenol
15. 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 OtherSa
38. UV254
)5939
39. Aumnum(utalS
59.
Potassium
40) Antimony
60. Selenium
1. Arsenic
61. Silver
Barium
62. Sodium
43 Beryllium
Boron
63. Thallium
64. Vanadium
45.Cadmium
65. Zinc
46. Calcium, as CaCos
CLP
47 Calcium, Ca*2
66. Metals/CN
48. Chromium, Total
67- Volatiles
49. Chromium, Hexavalent
68. Semi-violatiles
50,Cobalt
69 Pesticides/PCBS
51. Copper
70. Disk Deliverables
52 Iron
TCLP
53.Lead
ZI TCLP Metad
54 Magnesium
72,TCLP Pesiicides
55 Manganese
73, TCLP:Herbiados
56, Mercury
74,TCLP-Volatles
57) Molyboenum
58. Nickel
75 TCLP-BNAS
NYC-WTC_000072787
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