NYC 9/11 Public Portal Document
Westchester
gov.com)
ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM
WESTCHESTER COUNTY, LABORATORIES ANDRESFARCH
2.Dana,Road, Valhalla, New Yörk• 10595),
(914) 231-1620 "Fax (914),231-1772
Time/Date Set:
Sample:type. (circle one):
Potable
3. Nọn Potable Treated,
2. Non Potable:
4. Other
Time/Date Cöllected.
OEDO
712,/12
Collected By: _
Let+2
Agency Code:
Collected From:
Location's/Individual's Name
Nuc -DeP
Street _
19 l1).
INKP
City/St/Zip
Vallerlla
N/ 10573
Identification of Source
Collection Point
Drl18
VDA-DYHE
07588
Bottle #s::
Chain of Custody? :
Comments:
PWS#:_
Bill to:
Name/Company
Street .
City/St/Zip
Phone#:
Yes
Source ID
CA,CH, BІ?
BACTERIOLOGICAL ANALYSIS
Lab#:_
- Heterotrophic Plate Count
(hemodialysis & all others)
Coliform P/A (Public supplies)
Coliform MPN (priv well, raw, stp):
Fecal Coliformi (all"samples)
Microscópic.
_ Macroscopic
_ API
_ Other: _
Refrigerated? _
_ yes
Chlorinated:? -
_ yes.
Free Chlorine Res:1
Total Chlorine Res: _
-no
_no
_mg/L
_ mg/L
рH
Lab#:
ORGANIC POTABLE ANALYSIS
-Trihalomethanes (524)
4Volatile Halocarbons (524)
LVolatilë Aromatics (524)
_ Total Trihalomethane Potential (510)
Microéxtractables (504)
Pesticides/PCB screen (508).
PCB as Deçachlóröbiphenyl (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)
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.
Totà! Organic Halides:
Solids; Pêrcent: (%)*
Solids; Settleable:
Solids, Suspended,
Solids; Total.
Solids; Total Dissolved
solids Totál Volatile.
-Other:
Acidity
Alkalinity
Bromide
Bromate/Chlorate/Chlorite
Chloride
Cyanide
Eluoride:
Hardness, Total,as CaCO3•
Nitrogen: Ammonia as N,
Nitrogen: Nitrate as N
Nitrogen, Nitrite'as'N
Nitrogen, Total Kjeldahlas N:
Oil'and Grease
Phenol:
Phosphorus, Total as P.
Phosphorus! Ortho:as: Prt
Sülfates:
Surfactants,
UV254
Aluminum
w'Antimony
WArsenic
w.Barium
KBeryllium
-Boron
*Cadmiüm1
—Calciumi, as CaCos
- Calcium; Ca+2i.
Chromium, Totala
- Chromium, Hexavalente
uCobalt
topper
Vlon)
Lead
- Magnesium
‹Manganesej
4 Mercury
w Mölybdenum.
VNickelr
77
itrdte
NYC-WTC_000073325
•99т
пe
NYS:ELAP,NO 10108
Form A70
0(rev10701)
6945
CISTZ
_Týpe Descriptor:
Fax#:
:..: Check#:
Amount$:
ORGÁNIC NONPOTABLE/SOLID ANALYSIS
Pürgeable Halocarbons (624/8260)
→Purgeable Aromatics (624/8260)
Z Acrfeln & Acrylonitrile (8260)
«"Organochlorine Pesticides (608/8081)
SRPCB's,(Äröchlors): (608/8081) " **
Herbicides (SM18/6630,815) 3
3other Pesticides: (SM18/6630)
. Petroleum Hydrocarbon Scan (310-13)
Lay Glycols in Water
CLAcid Extractables : (625/8270)
VBäse Neutral Extractables (625/8270)
2EciMŞ Ünknown Ścän
Phthalates (606MS):
Other:
1,7..
Potassium
i s"Selenium.
Esilver
*Sodium
i Thallium +
→Janadium.
CLP
Metals/CN.
1.. Volațiles
=Semi-viólatiles
÷Pèsticides/PCB's;
ICLP
-TCLP-Metals
K—ICLP-Pesticides
ZrCLP:Herbicides;
IA TCLP'Volatiles:
TCLP-BNAŞI
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