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:
Sample Type (circle one):
1. Potable
3. Non Potable Treated
2. Non Potable
4. Other
Time/Date Collected:
1.28.020855
Collected By:
ScOT
Agency Code:
Collected From:
Location's/Individual's Name
NYC DEP
Street
MPSTLAKL
DKIVE
City/St/Zip
duct
MY
Identification of Source
Collection Point
DELS
nelo
NYS-ELAP No. 10108
Form A-70 (rev.10/01)
32961 8946-1K 102 590
Bottle #'s:
1E90 P2l035, P2634,0414
Chain of Custody?Yes No
LUnCTRBLAR
Comments:_
PWS #: -
Source ID:
LType Descriptor:
Bill to:
Name/Company
Street
City/St/Zip
Phone#:
Fax#:
CA,CH, BI?
Check#:
Amounts
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
API
Other:
Refrigerated? _ yes no
Chlorinated:?
- yes _ no
Free Chlorine Res:
_mg/L
Total Chlorine Res:_
_mg/L
рH
Lab#:_
ORGANIC POTABLE ANALYSIS
Trihalomethanes (524)
X Volatile Halocarbons (524)
Volatile Aromatics (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
MIBE 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)
X GC/MS Unknown Scan
Phthalates (606MS)
Other:
RADIOCHEMICAL ANALYSIS
Radon
Other
INORGANIC ANALYSIS REQUESTED - Lab#:
Color
Turbidity
Acidity
Alkalinity
рH
Bromide
Conductivity
Bromate/Chlorate/Chlorite
Corrosivity (temp:
BOD (5 day)
°C)
*Chloride
Carbonaceous BOD (5 day)
Cyanide
Fluoride
Soluble BOD (5 day)
Hardness, Total as CaCO3
Chemical Oxygen Demand
Nitrogen, Ammonia as N
Dissolved Oxygen
Nitrogen, Nitrate as N
Total Organic Carbon
Nitrogen, Nitrite as N
Total Organic Halides
Nitrogen, Total Kjeldahl as N
Solids, Percent (%)
Oil and Grease
Solids, Settleable
Phenol
Solids, Suspended
Phosphorus Total as P
Solids, Total
Phosphorus, Ortho as P
Solids, Total Dissolved
Sulfates
Solids, Total Volatile
Surfactants
Other:
UV254
Aluminum
XAntimony
Arsenic
Barium
&Beryllium
Boron
Cadmium
Calcium, as CaCO3
-Calcium, Ca*2
Chromium, Total
,Chromium, Hexavalent
ZCobalt
Copper
Xlron
Lead
Magnesium
X Manganese
_Mercury
2 Molybdenum
Nickel
Potassium
Selenium
Silver
Sodium
&Thallium
Vanadium
Zinc
CLP
Metals/CN
Volatiles
Semi-violatiles
Pesticides/PCB's
TCLP
1CLP-Metals
TCLP-Pesticides
TCLP-Herbicides
TCLP-Volatiles
TCLP-BNAS
NYC-WTC_000073078
OCR can misread numbers and units. Confirm readings against the page image before using them.