NYC 9/11 Public Portal Document
ENVIRONMENTAL SERVICES SAMPLE SUBMISSICa8i3f^6Kvr 3
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ov.com WESTCHESTER COUNTY LABORATORIES AND RESEARCH
2 Dana Road, Valhalla, New York 10595
(914)231-1620 Fax (914) 231-1772 BSI x
y^YS-ELAP No. 10108 _
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Time/Daie Set: // FormA-70(rev.10/01)
6? CT
Sample Type (circle one):
((57Potabl^ 3. Non Polable Treated Bottle #’s: ‘K
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2. Non Potable 4. Other Chain of Custody?___ Yes___ No
Time/Date Collected; ' 7 ' J t- Comments;
Collected Agency Code: PWS #:______ Source ID: .Type Descriptor:
I
Collected From: Bill to;
Location's/lndividual’s Name <3 Name/Company
Street________ _________________ Street_______
City/SVZip__________ ___________ City/St/Zip
Identification of Source Phone#; Fax#;
Collection Point_______
CA.CH, Bl? Check#: Amounts.
BACTERIOLOGICAL ANALYSIS Lab#:
Lab#;_______________________
ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLID ANALYSIS
__ Heterotrophic Plate Count
I (hemodialysis & all others) __ Trihalomethanes (524) __ Purgeable Halocarbons (624/8260)
__ Coliform P/A (Public supplies) __ Volatile Halocarbons (524) __ Purgeable Aromatics (624/8260)
__ Coliform MPN (priv well, raw. stp) __ Volatile Aromatics (524) __ Acrolein & Acrylonitrile (8260)
__ Fecal Coliform (all samples) __ Total Trihalomethane Potential (510) __ Organochlorine Pesticides (608/8081)
__ Microscopic __ Microextractables (504) _ PCB's (Arochlors) (608/8031)
__ Macroscopic __ Pesticides/PCB screen (508) _ Herbicides (SM18/6630,6151)
_ API __ PCB as Decachlorobiphenyl (508A) __ Other Pesticides (SM18/6630)
__ Other:_______________ ' __ Herbicides (515) __ Petroleum Hydrocarbon Scan (310-13)
__ Pesticides (525) __ Glycols in Water
Refrigerated?yes___ no __ Carbamate Pesticides (531) __ Acid Extractables (625/8270)
J __ Glyphosate (547) __ Base Neutral Extractables (625/8270)
Chlorinated:?yes___ no
__ Diquat (549) .j^6c/MS Unknown Scan
Free Chlorine Res:mg/L __ Chlorination Disinfection Byproducts (551) _ Phthalates {606MS)
Total Chlorine Res:mg/L __ Haloacetic Acids (552) __ Other;___________________________
pH ___________ _Other Pesticides (SMI8/6630)
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RADIOCHEMICAL ANALYSIS _MtBE Only (524)
__ Radon
__ Other____________________
INORGANIC ANALYSIS REQUESTED - Lab#:
__ Color __ Acidity '^Aluminum __ Potassium
__ Turbidity __ Alkalinity Antimony ^Selenium
I _ pH __ Bromide Arsenic ~^Silver
__ Conductivity __ Bromate/Chlorate/Chlorite _/Barium __ Sodium
__Corrosivity (temp;. ;c) __ Chloride _^eryllium '-thallium
_ BOD (5 day) __ Cyanide __ Boron __ Vanadium
__ Carbonaceous BOD (5 day) __ Fluoride __ Cadmium _:::Z'2inc
__ Soluble BOD (5 day) __ Hardness, Total as CaCOs __ Caldum, as CaCOs OlS
__ Chemical Oxygen Demand __ Nitrogen, Ammonia as N __ Calcium, Ca*’
__ Dissolved Oxygen __ Metals/CN
__ Nitrogen, Nitrate as N j^Gbromium, Total __ Volatiles
__ Total Organic Carbon __ Nitrogen. Nitrite as N __ Chromium, Hexavalent
__ Semi-violatiles
__ Total Organic Halides __ Nitrogen, Total Kjeldahl as N zTCobalt
I __ Pesticides/PCB’s
__ Solids, Percent (%) __ Oil and Grease ^Cooper
__ Solids, Settleable __ Phenol Iron
__ Solids, Suspended __ Phosphorus Total as P -TLead
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__ TCLP-Metals
__ Solids, Total __ Phosphorus, Ortho as P __ Magnesium
__ TCLP-Pesticides
__ Solids, Total Dissolved __ Sulfates j^jj^Manganese
__ TCLP-Herbicides
__ Solids, Total Volatile __ Surfactants j^^ercury
xifbther: _ TCLP-Volatiles
_ UV254 __ Molybdenum _ TCLP-BNAs
Nickel
J___________ SO'd 6016 300C8_g3J
NYC-WTC_000073505
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