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:
nelc
NYS-ELAP No. 10108
Form A-70 (rev.10/01)
Sample Type (circle one):
A. Potable
3. Non Potable Treated
2. Non Potable
4. Other
Time/Date Collected:
550
Collected By: D.aai011
1-21-cс
. Agency Code: _
Collected From:
Location's/Individual's Name A/~C De P
Street11
TCORSTLAKE
DI2NC
City/St/Lip
veeleilla l
Identification of Source
Collection Point_
Ca (GIP
4rla kini
Bottle #s: 12591,0021 42229.2145
Chain of Custody? Yes No
Comments:
PWS #: -
Source ID:
Bill to:
Name/Company
Street
City/St/Zip
Phone#: _
Fax#:
Type Descriptor:
CA,CH, BІ?
Check#:
Amount$
BACTERIOLOGICAL ANALYSIS
Lab#:
Lab#
Heterotrophic Plate Count
(hemodialysis & all others)
Coliform P/A (Public supplies)
Coliform MPN (priv well, raw, stp)
Fecal Coliform (all samples)
Microscopic
Macroscopic
API
Other:
Refrigerated?
- yes
Chlorinated:7
Free Chlorine Res:
Total Chlorine Res: _
yes - no
mg/L
mg/L
pH
ORGANIC POTABLE ANALYSIS
Trihalomethanes (524)
Volatile Halocarbons (524)
/Volatile Aromatics (524)
Total Trihalomethane Potential (510)
Microextractables (504)
Pesticides/PCB screen (508)
PCB as Decachlorobipheny (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
AcidExtractables (625/8270)
Base Neutral Extractables (625/8270)
GC/MS Unknown Scan
Phthalates (606MS)
Other:_
RADIOCHEMICAL ANALYSIS
Radon
Other
INORGANIC ANALYSIS REQUESTED - Lab#:
_ Color
Turbidity
рH
Conductivity
Corrosivity (temp:
°C)
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
ae Other:
Acidity
Alkalinity
Bromide
Bromate/Chlorate/Chlorite
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
LAntimony
_Arsenic
Barium
kBeryllium
Boron
Cadmium
Calcium, as CaCO3
_Calcium, Ca+2
_Chromium,Total
Chromium, Hexavalent
Cobalt
Copper
fron
Lead
*Magnesium
_Manganese
_Mercury
y Molybdenum
Nickel
Potassium
Selenium
Silver
Sodium
LLThallium
Vanadium
Zinc
CLP
Metals/CN
Volatiles
Semi-violatiles
Pesticides/PCB'S
TCLP
TCLP-Metals
TGLP-Pesticides
TCLP-Herbicides
TOLP-Volatiles
TCLP-BNAS
NYC-WTC_000073060
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