NYC 9/11 Public Portal Document
Westchester
eov.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:
0900
Collected By: C
12860
10/22/01
Agency Code:
Collected From:
Location's/Individual's Name
муслЕР
Street 14 uest lAllE Drive
ciy/stzip (h (laulla Mu
10595
Identification of Source
Collection Point_De/ 18
NYS-ELAP No. 10
Form A-70 (rev. 1/90
C-03IS
K-825C:264,8265,0025
P:9287,92819278 Q.9250.9224,7252
Bottle #s:
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/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
6. Macroscopic
7. API
8. Other:
Refrigerated?
yes
Chlorinated:?= yes_ no
Free Chlorine Res:
Total Chlorine Res:
- по
mg/L
mg/L
pH
Labf:
(circle tests)
Trihalomethanes (524)
2. Volatile Halocarbons (524)
Volatile Aromatics (524)
Total Trihalomethane Potential (510)
5.-
Microextractables (504)
6. Pesticides (507)
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. pH
22. Bromide
4.
Conductivity
23. Bromate/Chlorate/Chlorite
Corrosivity (temp::
°C)
24. Chloride
6.
BOD (5 day)
25. Cyanide
7
Soluble BOD (5 day)
26. Fluoride
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. Other:
38. UV254
148
so numnm MctalS
(40, Antimony
41. Arsenic
42. Barium
(43-Beryllium
44. Boron
45. Cadmium
46. Calcium, as CaCO3
47.Calcium, Ca*2
48. Chromium, Total
49. Chromium, Hexavalent
50 Cobalt
51. Copper
52) Iron
53.Lead
54 Magnesium
55 Manganese
56. Mercury
57)Molybdenum
58. Nickel
59. Potassium
60. Selenium
61. Silver
NM
(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-BNAS
NYC-WTC_000072839
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