NYC 9/11 Public Portal Document
Westchester:
gov.com:
ENVIRONMENTAL SÉRVICES SAMPLE SUBMISSIONIFORM:
WESTCHESTER COUNTY LABORATORIÉS; AND RESEARCH
2 Dana 'Road, Valhalla,:New York. 10595,
(914),231-1620"Fax (914) 231-1772
• Time/Date Set:
Sample Type (circle onie):
-7. Potable)
• 3. Nọn Potable Treated:
12. Non Potable
4-Othër_
Time/Date Collected: =- a §03
Collected By: 12?
1T111D
2/1/0z
Agency Code:
Collected From:
Location's/individual's Name
Street _
LLARC
MC-11
br.
City/St/Zip -
Dalhallee
10595
identification of Source
Collection PointCAT Leff
inehcy
NYS-ELAP:No: 10108
FóґmÃ-70"(rẹv.1ỔÌ01).
UDA-0*32
152,6
C*387
17600.2640
F 2775,2776
Bottle #'s:
Chain of Custody?
-Yes-No™!
Comments:
PWS#:
Sốurce ID: _
_Type Descriptor:*.*
Bill to:
Name/Company
Street _
City/St/Zip
Phone#:
Fax#:
CA, CH, BI?
ECheck#:
=Amount$
BACTERIOLOGICAL ANALYSIS
Lab#:
Heterotrophic Plate Count
(hemodialysis & all others)
Coliform P/A (Public supplies)
Coliform MPN
(priv well, raw, stp)
Fečal Coliform (all samples)
Microscopic
_ Macroscopic :
API:
_ Other:.
Refrigerated?
_ yes"
no:
Chlorinated:?.=
_yes_nos
Free Chlorine Res:
mg/L
Total Chlorine Res:
-mg/L
pH
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)
- Cärbamate Pesticides (531)
-Glyphosate (547)
Diquat' (549)
- Chlorination Disinfection Byproducts: (551)}
Haloacetic Acids . (552)
_Óther Pesticides (SM18/6630)"
UCMR List 1
_MtBE Orly (524)
ORGANIC NONPOTABLE/SOLID ÄNALYSIS
e Purgeable. Hälocarbons (624/8260)
*Purgeable Aromatics (624|8260).
→ Acroiein & Acryonitrile: (8260)
*§Organöchlorine Pesticides. (608/8081)
PCB's (Arochlors): (608/8081),*
Herbicides (SM18/6630,8151)
Other Pesticices; SM18/6630),
2 Petroleum Hydrocarbon Scan, (310-13)
Eclycols in Water,
Acid Extractables: (625Ï827O)...
* Base Neutral Extractablés (625/8270),
GC/MS Unknown Scan*
Phthalates (606MS)
Other:
RADIOCHEMICAL ANALYSIS
Radon
Other
-.-
INORGANIC ANALYSIS REQUESTED - Lab#:
- Color
Turbidity.
_.pH
Conductivity
Corrosivity (temp:__
• °C)
BOD (5 day)
Carbonaceous BOD (5 day)
Soluble BOD. (5 day)
Chemical Oxygen Demand
÷ Dissolved'Oxygen
Total'Örganic Carbon
→ Total Organic Halidés
=
Solids, Percent: (%))
. Solids, Settleable)
Solids Suspended!
Solids, Total
Solids, Tốtal.Dissólvęd;
Solids; Total,Volatile]
ie Other:
Acidity
Alkalinity
Bromide
Bromate/Chlorate/Chlorite
Chloride
Cyanide
Fluoride,
Hardness: Total as CaCOз
Nitrogen, Ammonia as N.
Nitrogen;; Nitrate as N
=
Nitrogen; Nitrite as N
=
Nitrogen, Tofal Kjeldahl as N:
Oiland:Grease:
_ Phenol!
Phosphorus Total as P)
Phosphorus; Ortho as Pr
Sulfates!
Surfactants)
UV254i
Aluminum
"¿.
iAntimony'
LeArsenic::
½Barium;
ézBeryllium
-
Boron.
«Cadmium›
Calcium, asCaCO3
- Călcium; Ca+2KE
¿ehromium) Total:
_Chromium, Hexavalént?
1Cobalta
Copper:
Tron)
ILead!
= Magnesium»
VaManganese:
« Mercuryr
4 Molybdenum:
Nickeli
•. =
=.
→Potassium:
Selenium
Silver:
-Sodium
Thallium
Vanadium
Zino
CLP:
= Mètals/CN:
Ter
: Volatiless
Semi-violatiles.
_Pesticides/PCB's
ICiLP
+ICLP-Metals
:TCLP-Pesticides!
-TCLP Hérbicides)
..TCLP-Volațiles,
- TCLP-BNA'S:
NYC-WTC_000073330
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