NYC 9/11 Public Portal Document
Wlestchester County
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
Time/Date Collected:
1.31.020842
Collected By:L. Sco7T
Agency Code:_
Collected From:
Location's/Individual's Name
N/CDEP
IDeSt CAKi TXNVE
City/St/Zip
VALHALLA,
ру 10-595
Identification of Source
Collection Point 0/2o (ctl
NYS-ELAP No. 10108
QFe 8ahC116l, 91929
Form A-70 (rev. 1/96)
Bottle #'s:
P2133
,P2132
PRELLERIONOZ
Chain of Custody?
yes
_no Kz5, kz57
,кеb
Comments:
KVO TENBARIC
PWS #:
Source ID:
Type Descriptor:
Bill to:
Name/Company
Street
City/St/Zip
Phone#
Fax #:
CA, CH, BI?
Check#:
Amount$
BACTERIOLOGICAL ANALYSES
ORGANIC POTABLE ANALYSES
ORGANIC NONPOTABLE/SOLID ANALYSES
Lab#:
(circle tests)
1. Heterotrophic Plate
Count (hemodialysis & all others)
2. Coliform P/A (public supplles)
3. Coliform MPN (priv well, raw, stp)
4. Fecal Coliform (all samples)
5. Microscopic
6. Macroscopic
7.AP.
8. Other:
Refrigerated?
yes
no
Chionnated?:
yes
Free Chiorine Res
mg/L
Total Chlorine Res:
mg/L
Lab #:
(circle tests)
1. Trihalomethanes (524)
2.) Volatile Halocarbons (524)
13.
4.
Volatile Aromatics (524)
Total Trihalomethane Potential (510)
5
Microextractables (504)
6.
Pesticides (507)
7. 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. Other Pesticides (SM-18/6630)
17. Petroleum/Hydrocarbon Scan (310-13)
1. Purgeable Halocarbons (624/8260)
2. Purgeable Aromatics (624/8260)
3.
4.
Acrolein & Acrylonitrile (624)
Phthalates (606/8060)
5. Organochlorine Pesticides (608/8080)
6. PCB's (Arochlors) (608/8080)
7. Herbicides (SM-18/6640; 8151)
8. Other Pesticides (SM-18/6630)
9. Petroleum Hydrocarbon Scan (310-13)
10. Glycols in Water
11.Acid Extractables (625/8270)
12, Base Neutral Extractables (625/8270)
13. GC/MS Unknown Scan
14. Purgeable Halocarbons (DEF)
15. Purgeable Aromatics (DEF)
16. Pesticides (DEF)
17. PCB's (Arochlors) (DEF)
pH
INORGANIC ANALYSES REQUESTED - Lab#:
(circle tests)
1. Color
2.
Turbidity
3.
рH
Conductivity
5
Corrosivity (temp:
°C)
6
BOD (5 day)
7.
Soluble BOD (5 day)
8. Carbonaceous BOD (5 day)
9. Chemical Oxygen Demand
10. Dissolved Oxygen
11. Total Organic Carbon
12. Total Organic Halides
13. Solids, Percent (%)
14. Solids, Settleable
15. Solids, Suspended
16. Solids, Total
17. Solids, Total Dissolved
18 Solids, Lotal Volatile
19 Other
20. Acidity
21. Alkalinity, as CaCO3
22. Bromide
23. Bromate/Chlorate/Chlorite
24. Chloride
25. Cyanide
26. Fluoride
27. Hardness, Total as CaCO3
28. Nitrogen, Ammonia as N
29. Nitrogen, Nitrate as N
30. Nitrogen, Nitrite as N
31. Nitrogen, Total Kjeldahl as N
32. Oil and Grease
33. Phenol
34. Phosphorus, Total as P
35. Phosphorus, Ortho as P
36, Sulfates
37 Surlactants
38. LIV254
2571
39. Aluminum
40. Antimony
41. Arsenic
42. Barium
(43. Beryllium
44. Boron*
45. Cadmium
46. Calcium, as CaCO,
47. Calcium, Ca*?
48. Chromium, Total
49. Chromium, Hexavalent
51. Copper
(52/Iron
53. Lead
54. Magnesjum
55. Manganese
56. Mercury
(57. Molybdenum
58. Nickel
59. Potassium
60. Selenium
61. Silver
62. Sodium
63. Thallium
64. Vanadium
65. Zinc
CLP
66. Metals/CN
67. Volatiles
68. Semi-volatiles
69. Pesticides/PCB S
70. Disk Deliverables
TCLP
7147CLP-vetals
72. TCLP-Pesticides
73. TCLP-Herbicides
74, TCLP-Volatiles
75,TCLP BNA S-
NYC-WTC_000073235
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