NYC 9/11 Public Portal Document
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ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM
WESTCHESTER COUNTY LABORATORIES AND RESEARCH
2 Dana Road, Valhalla. New York 10599
,._. ...y^ ?)
(914)593-5579
nme/Dat© Set: ^A-7Q(reY.W) /J
Stompteiype (circle one):
potable 3. Non Potable Treated Bottidjrs:
2. Non Potable 4. Other , ...■ . Ctem of Custody? i_4w»X- -2?1
Time/Date Collected: C-^ifP /4/r >r- Commente: 'J/ ;
6dBectedi^:^-^<^M^<gK AganeyCode: pws a
Collected From:
Location’s/lndividuars Name.
Street ________
.
NKneiCdrapi^
,Y -1'
j
City/St/Zip_„___ City/StZap„__.
7^
3
t . Identification of Source 2__<
t Coilectfori Point
rcASSTBfFZZ-
BACTERIOLOGICAL ANALYSIS ' ORGANIC POTABLE ANALYSIS 0
y'^Y<
(circle tests) '........... ■/ye
t.Heterotrophlc Plate ■ 1. Trihaldmethanes (524) 0<. ^.. f
Count (hemodialysfe & all others) 2.Vol8tiieHalocarbons(524) y y.
t M /(puW supplies)
3. Coliform MPN (prfv well, raw, stp)
3. Voiatite Aromatics (524)
4.TotatTrihatom0than8PQtential(5iO) s*®s«SSS'«
* poBlfoml (an samples)
■9.;P^s8d^;(6Qh'^^^^
J' aa?.
’6."PCSi
wj^D y .■>
A.
Wil ft 7. P8sticid©s/PCBscreen(508)
8, PCBaspecachlorobiphenyl (508A)
i Refrigerated? _ yes. no
I .cO^^—'y»s. __ no
11. Cart^amate Pesficides (531)
la Olyphosede (947) ,
Oa
!/'(62Si
t Free Chlorine Res: SUton%nfection Syproducts (K
'■-i
.•.13.
^Aluminum §I
■
’ Av
21.Alkafln«y.asCaGO3 j^’Antjj^ny
5
iSM K/YSj
iSLjpH 7 y22^BfdlW'< ,;y ; ■ ■< .3- ' ■
4,-C<»^jC^W YJ^^^^^ChlorW/CWdrito, - ;'
7.So|ubleBOD(5day) «
sjijs^ya
8.Carbonac8ousBOD(5day)
r&8*» *■< HOE--:.;- wS
S. Chemlcai Oxygen Demand
lO.Dissolved Oxygen sagjiaa?” nSn^ftial ■'/■ .' 3..*y its
ifc; H-TotalOrganicCarbon
12. TotaI Organic Halides
13. So«ds, PerC0n{ {%) ® ‘........... L3Si3^Ia5Si^
stt#
14.Solids.SeW§able
15/Solids, Suspended 34.Phosphorus Tbtal asP ;53.Lead iW
t^8ollds,Tt^ 35. Phosphorus. Ortiio as P
17. Solids, Total Dissolved 36. Sulfates
IS
J
l8.Solids, T^ai Volatile 37. Surfactants
<f^Other;JZn 38.UV254 o Y
■s. Ml
■ gSB8
NYC-WTC_000074901
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