NYC 9/11 Public Portal Document
Westchester
gov.com
ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM
WESTCHESTER COUNTY LABORATORIES AND RESEARCH
2 Dana Road, Valhalla, New York 10595
(914) 231-1620 Fax (914) 231-1772
Time/Date Set:
nelac
NYS-ELAP No. 10108
Form A-70 (rev.10/01)
Sample Type (circle one):
1. Potable
3. Non Potable Treated
2. Non Potable
4. Other
Time/Date Collected:
1/27/0z
Collected By:
b
Agency Code: A/tyE
Collected From:
Location's/Individual's Name
Field
Blank
Street
City/St/Zip
Identification of Source
Collection Point
FBIN
Bottle #'s:
P808,Q512
Chain of Custody? _Yes No
Comments:
PWS #:
Source ID:
Bill to:
Name/Company
Street
City/St/Zip
Phone#: .
Fax#:
Type Descriptor:
CA,CH, BI?
Check#:
Amount$
BACTERIOLOGICAL ANALYSIS
Lab#: _
Heterotrophic Plate Count
(hemodialysis & all others)
Coliform P/A (Public supplies)
Coliform MPN (priv well, raw, stp)
Fecal Coliform (all samples)
Microscopic
Macroscopic
APL
Other:
Refrigerated? _
yes
no
Chlorinated:?
- yes _ no
Free Chlorine Res:
-mg/L
Total Chlorine Res:
_mg/L
рH
Lab#:
ORGANIC POTABLE ANALYSIS
Trihalomethanes (524)
Volatile Halocarbons (524)
Total Trihalomethane Potential (510)
Microextractables (504)
Pesticides/PCB screen (508)
PCB as Decachlorobiphenyl (508A)
Herbicides (515)
Pesticides (525)
Carbamate Pesticides (531)
Glyphosate (547)
Diquat (549)
Chlorination Disinfection Byproducts (551)
Haloacetic Acids (552)
Other Pesticides (SM18/6630)
UCMR List 1
MtBE Only (524)
ORGANIC NONPOTABLE/SOLID ANALYSIS
Purgeable Halocarbons (624/8260)
Purgeable Aromatics (624/8260)
Acrolein &Acrylonitrile (8260)
Organochlorine Pesticides (608/8081)
PCB's (Arochlors) (608/8081)
Herbicides (SM18/6630,8151)
Other Pesticides(SM18/6630)
Petroleum Hydrocarbon Scan (310-13)
Glycols in Water
Acid Extractables (625/8270)
Base Neutral Extractables(625/8270)
XGC/MS Unknown Scan
Phthalates (606MS)
Other:
RADIOCHEMICAL ANALYSIS
Radon
Other
INORGANIC ANALYSIS REQUESTED - Lab#:
Color
Turbidity
pH
Conductivity
Corrosivity (temp:
BOD (5 day)
Carbonaceous BOD (5 day)
Soluble BOD (5 day)
Chemical Oxygen Demand
Dissolved Oxygen
Total Organic Carbon
Total Organic Halides
Solids, Percent (%)
Solids, Settleable
Solids, Suspended
Solids, Total
Solids, Total Dissolved
Solids, Total Volatile
Other:
Acidity
Alkalinity
Bromide
Bromate/Chlorate/Chlorite
°C)
Chloride
Cyanide
Fluoride
Hardness, Total as CaCO3
Nitrogen, Ammonia as N
Nitrogen, Nitrate as N
Nitrogen, Nitrite as N
Nitrogen, Total Kjeldahl as N
Oil and Grease
Phenol
Phosphorus Total as P
Phosphorus, Ortho as P
Sulfates
Surfactants
UV254
Aluminum
Antimony
Arsenic
Barium
Beryllium
Boron
Cadmium
Calcium, as CaCO3
Calcium, Ca+2
Chromium, Total
Chromium, Hexavalent
Cobalt
Copper
Iron
Lead
Magnesium
Manganese
Mercury
Molybdenum
"Nickel
Potassium
Selenium
Silver
Sodium
Thallium
Vanadium
Zinc
CLP
Metals/CN
Volatiles
Semi-violatiles
a Pesticides/PCB's
TCLP
TCLP-Metals
TCLP Pesticides
TCLP-Herbicides
TCLP-Volatiles
TCLP-BNAS
NYC-WTC_000073057
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