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
Timo/Date Set:
Sample Type (crcle one):
Potable
3. Non Potable Treated
2a von Potable
4. Other _
Ime/Date Collected
Collected By: .
Lab
Collected From:
Location's/Individual's Name
Street
.City/StZip
Identification of Source
Collection Point
02
Agency Code:NeNE
Field Blank
nebct
NYS-ELAP No. 10108
Form A-70 (rev 10/01)
Bottle #'s:
P 1610,02894
Chain of Custody?.
iiYos.
_ No
Comments:
PWS #:.
Source ID:
_Type Descriptor::
Blll to:
Name/Company
Street
City/St/Zip
Phone#:
Fax#:
Fblu
CA,CH, BI? -
:Check#:
Amounts
BACTERIOLOGICAL ANALYSIS
Lab#:
Heterotrophic Plate Count
(hemodialysis & all others)
Coliform PIA (Public supplies)
Coliform MPN (priv well, raw, stp)
L Fecal Coliform (all samples)
a Microscopic
- мacroscopic
2 APFC
¿Other:
Refrigerated? -
-yes _ nO
Chiorinated:?_ yes —no
Free Chiorine Res:
_mg/L
Total Chiorine Res:
_mg/L
Lab#:
ORGANIC POTABLE ANALYSÍS
_Trihalomethanes (524)
Volatile 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/ SÓLID ANALYSIS
Purgeable Halocarbons (624/8260)
-Purgeable Aromatics (624/8260)
Acroleln & 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)
XGC/MS Unknown Scan
Phthalates (606MS)
Other:
RADIOCHEMICAL ANALYSIS
Radon
Other
INORGANIC ANALYSIS REQUESTED - Lab#:
Color
- Acidity
Turbidity
- Alkalinity
pH
_ Bromide
Conductivity
_ Bromate/Chlorate/Chlorite
Corrosivity (temp:
°C)
_ 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
Solids, Suspended
Phosphorus Total as P
Solids, Total
Phosphorus, Ortho as P
Solids, Total Dissolved
Sulfates
Solids, Total Volatile
Surfactants
Other:
UV254
• Aluminum
Antimony
Arsenic
Barium
Beryllium
Boron
Cadmium
Calcium, as CaCOs
Calcium, Cat?
Chromium, Total
Chromium, Hexavalent
Cobalt
Copper
Iron
Lead
Magnesium
Manganese
Mercury
Molybdenum
Nickel
- Potasslumi
_ Selenium
: Sliver :
Sodlum
- Thallium
Vanadium
Zinc
CLP
Metals/CN
_Volatiles
,Semi-violatiles
,Pesticides/PCB's
ICLP
_TCLP-Motals
_ TCLP-Pesticides
TCLP-Herbicides
: TCLP-Volatiles
,TCLP-BNAs
NYC-WTC_000074974
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