NYC 9/11 Public Portal Document
Westchester
pov.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:
nelo
NYS-ELAP No. 10108
Form A-70 (rev.10/01)
Sample Type (circle one):
1. Potable
2. Non Potable
Time/Date Collected:
Collected By:_
Lab
Collected From:
Location's/Individual's Name
Street
City/St/Zip
Identification of Source
Collection Point
3. Non Potable Treated
4. Other _
2/1/02
Agency Code: NCWz
Field Blnk
Bottle #'s:
P 1005, 0832
Chain of Custody?
_ Yes
-No
Comments:_
PWS #:
Source ID:
Bill to:
Name/Company
Street
City/StZip
Phone#:
Fax#:
Type Descriptor: .
FBIJ
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
API
Other:
Refrigerated?.
_ yes
Chlorinated:?
_ yes_
_ no
Free Chlorine Res:
- mg/L
Total Chlorine Res:
_mg/L
рH
RADIOCHEMICAL ANALYSIS
Radon
Other
Lab#:
ORGANIC POTABLE ANALYSIS
Trihalomethanes (524)
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
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)
GC/MS Unknown Scan
Phthalates (606MS)
Other:
INORGANIC ANALYSIS REQUESTED - Lab#:
- Color
- Acidity
Turbidity
Alkalinity
pH
Bromide
Conductivity
Bromate/Chlorate/Chlorite
Corrosivity (temp:
°C)
Chloride
BOD (5 day)
Cyanide
Carbonaceous BOD (5 day)
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
Antimony
Arsenic
Barium
Beryllium
Boron
Cadmium
_Calcium, as CaCO3
_Calcium, Cat2
_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
Pesticides/PCB's
TCLP
TCLP-Metals
TCLP-Pesticides
TCLP-Herbicides
TCLP-Volatiles
TCLP-BNAS
NYC-WTC_000073256
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