NYC 9/11 Public Portal Document
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2 Dana Road, Valhalla. New York 10595
;9H).231 1620 Fax (914) 751-177?
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NYS ELAP Ne. 10168
Time/Date Set; r /Z317ZA..^4^Y Form A-70(rev.10/01)
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sample Type
( VPotable 3. Non Potable Treated
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-• .Bottle-#*s: C~t2."7(
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(,<' r-< ___
2. Non Potable 4. Other Chain of Custody?Yes No
Time/Date Collected: QQ | Z Comments:
Q„ii—o,„ / La.., \gency Code: PWS #;_______ Source ID:Type Descriptor;
Culicctod From. Bill to
Location’s/lndividual’s Name I? v ‘ ____ - Name/Company
Street___ iZ___ Wf L. t / ..V t____ Tof , vdC.____ , Street________
City/St/Zip _j2£iXH£<JlLL_^^ City/SVZip J
Identification of Source_______________ _______________i Phone#; Fax#:„
Collection Point C. fe O (3 E| i
CA,CH, Bl? _ Check#: Amount?.
BACTERIOLOGICAL ANALYSIS
Lab#:___________________________
ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABt. E/SOLID ANALYSIS
__ Heterotrophic Plate Count
(hemodialysis & all others) __ Trihaiomethanes (524) ___ Purgeabie Halocarbons (624/8260)
. ,.'Vol;i!ik: H.ilocsii!..7ns in>-5) . Purg.-nnio Aromnlin. {!i24#i?Ufh
__ Coliform P/A (Public supplies)
__ Coliform MPN (priv well, raw, stp) ..-Volatile Ar-m.=!kt.; .. Aer.'lom & Aoryionit.iie (8:>6U)
__ Fecal Coliform (all samples) __ Total Trihalomethane Potential (510) __ Organochlorine Pesticides (608/8081)
__ Microextractables (504) Z_^ PCB’s (Arochlors)' (608/8081)
„„ Microscopic
Macroscopic
Z Other:_______________ _ ______
zSkmisss, '
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Refrigerated?yes
Chlorinated:? yes
no
no
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_ Glyphosate (547)
... Diquat (54?)
. Aetd Lxtmoiahiec (ii.dviOVm
Base Neutral Extractables (625/8270)
..t-^5C^MS unknown Senn
a® Free Chlorine Ros ...... mg/i __ Chlorination Disinfection Byproducts (551) ___Phthalates (606MS)
Total Chlorine Res:...y i mg/L ___ Haloacetic Acids (552) ___ Other:
__ Other Pesticides (SM18/6630)
pH ---------------------- y_____________
UCMR List 1 ■BBS
■ RAbiOf;HEM!CAL7^At.:YSIs''‘... _ MtBE Only (524) ItSi
___ Radom OU
__ Other J ■I
iNORGANSC ANALYSIS REQUESTED • I oi-Y
__ Color __ Aridity __ Aluminum __ Potassium
__ Turbidity __ Alkalinity IliillilllBilB
t Antimony __ Selenium
pH ___ Bromide __ Arsenic Silver ;
__ Conductivity ___ Bromate/Chiorate/Chlorite __ Barium Sodium
Corrosivity (temp:.;“C) __ Chloride _L^-'Beryllium Hianium
.fefThaliium
__ BOD (5 day) zSmIum Zan™*“'"
__ Carbonaceous BOD' (5 day)
___ Soluble BOD (5 day) __ Hardness. Total as CaCO3 i „ Calcium, as CaCOs 1-773----------------- slOl
__ Chemical Oxygen Demand
Dissolved Oxvuen
„ Total Organic Carbon
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. N,1,Nit,Ileus N
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. . Tot,, 11
_ Solids, Percent (%) ' ..... . |s
___ Solids, Settleable
Z S<4lds. Suspended t;--....... . ,
Phenol 3(ls
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__ Solids. Total CLKMoUib.
Sends. 101,11 Dissnived
yoKk., iblul yobWt, .. SurfucuinL- .Merrmv
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jv^ther: __________
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NYC-WTC_000072886
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