NYC 9/11 Public Portal Document
Testchester
gov.com:
Time/Date Set:
Sample Type (circle one):
Cotable
3. Non Potable Treated :
2. Non Potable
4. Other_
Time/Date Collected:
2:2002
Collected By: L. Wagner Agency Code:
Collected From:
Location's/Individual's NameNYC DEP
Street
19
Wesllake
Driuc
City/St/Zip _
Valballa, Ny
10595
Identification of Source
Collection, Point Cat de(t.
ENVIRONMENTAL SERVICEŚ SAMPLE SUBMISSION FORMI
19
ACÇORD
WESTCHESTER COUNTY L'ABORATORIES AND RESEARCH:
2"Dana:Road, Valhalla, New York: 10595:
(914) 231-1620 Fax (914) 231÷1772
nehct
• NYS-ELAP No: 10108im
PrB-Z76O.P-2478P-24751
Form.A7o (ev 10701)
@FB. 489 Q-2191
Q-2198
Botle #s: C-1294KTB 0406 K:9919v 9920
Chain of Custody?_ Yes;
- Nọ
K: 992)
Comments:
• PWS #:
_ Source ID:':
_Type Descriptor: _
Bill to:
Name/Company
. Street
City/St/Zip
Phone#:
_ Fax#:
CA,CH, BI?
Check#:
_ Amount$
BACTERIOLOGICAL ANALYSIS
Lab#:
Heterotrophic Plate Count
(hemodialysis & all others)
Coliform P/A (Public supplies)'
Coliform MPN. (priy well, raw, stp)
Fecal Coliform (all samples)
Microscopic
= Macroscopic
API
Other:
Refrigerated? _
-yes
Chlorinated:?
_ yes
Free Chlorine Res:_
Total Chlorine Res: _
- no
no
_ mg/L
_mg/L
рH
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
Total Organic Halides
Solids, Percent (%):
Solids, Settleable
Solids, Suspended
Solids: Totäl.
Solids, Total'Dissolved;
Solids; Total Volatile!
L. Other: =
Làb#:
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)
Pésticides (525)
Carbamate Pesticides (531)
Glyphosate (547)
*Diquat (549)
Chlorinätion Disinfection Byproducts (551)
Haloacetic Acids (552)
Other Pesticides (SM18/6630)
_ UCMR List 1
MIBE Only, (524)
+: Ihsirs
2712
Acidity
Alkalinity
Bromide +.
Bromate/Chlorate/Chlorite
Chloride
- Cyanide
Fluoride:
- Hardness, Total as CaCo3
Nitrogen, Ammonia as N
Nitrogen; Nitrate as'N."
Nitrogen, Nitrite as N
- Nitrogeni,Total.Kjeldahl as N.
Oiland Grease:
Phenol
Phösphorus;Total as P
Phosphorus; Ortho as P'
Sulfates!
*Surfactants,
7.UV254
Aluminum
li Antimony
LArsenic
1Barium
LBeryllium
- Boron
Lladmium:
Calcium, as Caco::
. Calcium, Cat?
Chromium, Total
''Chromium, Hëxávalent"
4Cobalt
LCopper
roni
iLeadi
- Magnesium:
Manganese:
¿Merculy"s
•Mötybdenum
witickels
_lar.
• ORGANIC NONPOTABLE/SOLID ANALYSIS
1 =Pugeabis Arocais (0246328250)
- 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);
Glýcols in Water:
Acid Extractables: (625/8270)
Base Neutral Extractables, (625/8270).*
LGC/MS Unknown.Scan:
Phthalates (606MS)
Other:_
Potassium
iselenium
iSiiver
Sodium
KThallium
-Vanadium
-Metals/CN
=Volatiles
E:Semi: Violatiles:
—Pesticidëș/CB's!
ICLe
-TCLP'Metals**
÷ TCLP Pesticides!
TCLP-Herbicides;
→TCLP,Volatiles)
= TCLP-BNA'S,
aisbenti
NYC-WTC_000073323
sE vedd"*ir
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