NYC 9/11 Public Portal Document
Westchester
ov.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:
Sample Type (circle one):
1Potable
3 Non Potable freated
3 Non Potable
4. Other
Time/Date Collected:
12:21 prp
2/2т/с2
Collected By: * +
Gertsie
Agency Code: _
Collected From:
Location's/Individual's Name
06503
Street.
City/St/Zip
Identification of Source _
Collection Point _
38650
ne
NYS-ELAP No. 10108
Form A-70 (rev. 10/01)
Bottle #s:
Ibс 1177. 2538,2247,077
Chain of Custody?.
Yes
No
Comments:
PWS #:
_ Source ID:
Type Descriptor:
Bill to:
Name/Company
Street
City/St/Zip.
Phone#:
Fax#
CA,CH, BІ?
.Check#:
Amounts
BACTERIOLOGICAL ANALYSIS
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
Ratrigerated?
yes
Chlorinated:?
_ yes
Free Chlorine Res:
Total Chlorine Res:.
,по
no
_ mg/L
_mg/L
pH
* RADIOCHEMICAL ANALYSIS
Radon )
Other
Lab#:
ORGANIC POTABLE ANALYSIS
Trihalomethanes (524)
- Volatile Halocarbons (524)
, Volatile Aromatics (524)
Total Trihalomethane Potential
Microextractables (504)
Pesticldes/PCB screen (508)
PCB as Decachloroblphenyl (508A)
Herbicides (515)
Pesticides (525)
Carbamate Pesticides (531)
Glyphosate (547)
LDiquat (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)
OtherPesticides (SM18/6630)
Petroleum Hydrocarbon Scan (310-13)
Glycols In Water
_ Acid Extractables (625/8270)
Base Noutral Extractables (625/8270)
7GC/MS Unknown Scan
Phthalates (606MS)
Other._
INORGANIC ANALYSIS REQUESTED - Lab#;
_ Color
Acidity
:Turbidity
pH
_ Alkalinity
Bromide
Conductivity
Bromate/Chlorate/Chiorite
Corrosivity (temp:.
Chloride
BOD (5 day)
Cyanide
Carbonaceous BOD (5 day)
Fluoride
Soluble BOD (5 day):
Hardness, Total as CaCO3
Chemical Oxygen Demand
Nitrogen, Ammonia as N
: Dissolved Oxygen
Nitrogen, Nitrate as N
Total Organic Carbon
Nitrogen, Nitrite as N
Total Organic Halides
Nitrogen, Total Kjeldahl as N
Solids, Percent (%)
Oil and Grease
Solids, Settleable
Phenol
Sollds, Suspended
Phosphorus Total as P
Sollds, Total
Phosphorus, Ortho as P
Solids, Total Dissolved
Sulfates
IOther.
Solids, Togr Yolatile
Surfactants
UV254
=04847
Aluminum
:Antimony
TrArsenic
TBarlum
VBerylllum
,Boron
Cadmium
Calcium, es CaCOs
_Calcium, Catz !
Chromlum, Total
Chromium, Hexavalent...
ICobalt
I copper
Viron
ELead
Magnesium
Manganese
Y Mercury
IMolybdenum
k Nickel
_ Potassium
ESelenlum
Silver
Sodlum
E Thalllung
_ Vanadlum
E znc
CLP
2L Metals/CN
- Voltiles
-Semi-violatiles
_Pestícldes/PCB's
ICLP
_TCLP-Metals
_ TCLP-Pesticides
_TCLP-Herbicides
TCLP-Volatiles
_ TCLP-BNA's
NYC-WTC_000074576
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