NYC 9/11 Public Portal Document
Westchester
gov.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:
neact
NYS-ELAP No. 10108
Form A-70 (rev.10/01)
Sample Type (circle one):
1 Potable
3. Non PotableTreated
2. Non Potable
4. Other
Time/Date Collected:
09,0
2•19-02
Collected By: L. Wagnsr
- Agency Code:
Collected From:
Location's/Individual's Name
NYC DEP
Street 19
WestLake
Dr.ve
City/St/Zip
Valhalla, NY
10595
Identification of Source
Collection Point Pel 18
Q- 1251
Q
1305
P.735
P- 1073
Bottle #'s:_6/S45
, Ктв, К 397, к. 398, к -399
Chain of Custody? Yes No
Comments: _
PWS #:_
Source ID:
Type Descriptor:.
Bill to:
Name/Company
Street
City/St/Zip
Phone#:
Fax#:
CA,CH, BI?
Check#:
Amount$
BACTERIOLOGICAL ANALYSIS
Lab#:
Lab#:
Heterotrophic Plate Count
(hemodialysis & all others)
Coliform PIA (Public supplies)
Coliform MPN (priv well, raw, stp)
Fecal Coliform (all samples)
Microscopic
Macroscopic
API
Other:
Refrigerated?
_ yes
Chlorinated:?
_ yes
L no
Free Chlorine Res:
mg/L
Total Chlorine Res:
mg/L
рH
ORGANIC POTABLE ANALYSIS
Trihalomethanes (524)
/olatile 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:_
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 Organic Carbon
Total Organic Halides
Solids, Percent (%)
Solids, Settleable
Solids, Suspended
Solids, Total
Solids, Total Dissolved
Solids, Total Volatile
Other:
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
Nitrogen, Total Kjeldahl as N
Oil and Grease
Phenol
Phosphorus Total as P
Phosphorus, Ortho as P
Sulfates
Surfactants
UV254
Aluminum
LAntimony
L Arsenic
Barium
Beryllium
- Boron
/Cadmium
_ Calcium, as CaCO3
Calcium, Ca*2
Chromium, Total
Chromium, Hexavalent
1Cobalt
rCopper
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
N TCLP-Pesticides
TCLP-Herbicides
TCLP-Volatiles
TCLP-BNAS
NYC-WTC_000074198
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