NYC 9/11 Public Portal Document
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ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM
WESTCHESTER COUNTY LABORATORIES Xfib RESEARCH
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2 Dana Road, Valhalla, New Yoit 10595
(914) 231-1620 Fax (914) 231-1772 II
No.-10108<;.S
._______ PFR -rgRT p-zwqu p. -2Mn .
Sample Type (circle one): 2^32^ 0-27*36^0^
3.toP0tebte7ieated wi.tfc C-e^e7 MTg-i6gQ<,u<
4. Other _________________ Chain of Custody? .__ Ye8 No
liTIme/Date Collected:--------
IOQ.Sr. ■■ Comments:
jrMa .r Agency Code: PWS #: Source ID: Type Descriptor:
? Collected From: Bill to:
T:>ep Name/Company
'Z
y citv/st/zip XGVV^ J tuKj
X>r>9t Street.______
lOSASl City/St/Zip
fc Identtfication of SourM, Phone#:-
I ^^^lectton Point UfCO 6 i4 !
I CA,CH,Bi? Check#: _ Amount$_____
9 BACTERIOLOGICAL ANALYSIS Lab#:
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ORGANIC POTABLE ANALYSIS
__ TJihalomethanes (524)
iy^atile Halocarbons (524)
ORGANIC NONPOTABLE/SOLID ANALYSIS
__ Purgeable Halocarbons (824/8260) '
1
supplies) _ Pui^eable Aromatics (624/8260)
MPN (priv well, raw, stp) _^*^latlle Aromatics (524) _ Acrolein & Acrjdonitrile (8260) /
(all samples). ' . __ Total Trlhalomethane Potential (510) __ Organochlorine Pesticides (608/8081)
Microscopic _ MIcroextractables (504) _ PCB’s (Arochiors) (608/8081)
;■ ^_^iMadpscopic __ PestIcides/PCB screen (508) _ HerblcldeS (SMl8^30.8151) -
'A
_PCBa8Decachloroblphenyi (508A) _ Other Pesticides (SMI 8/6630) ■
_Herbiddes (515) _ Petroleum Hydrocarbon Scan (310-13)
__ Pesticides (525) _Glycoi8lhwater Y ;
Refrigerated? yes no __ Carbamate Pesticides (531) _ Add Extiactables (625/8270)
Wcainwed:? ___ yes no • __ Glyphosate (547) __ Base Neutral Extractables (625/8270)
’S-'- _Diquat (549) X#*<Sfc/MS Ohknowm iScan.
Res:___ _mg/L _ Chlorination Disinfection Byproducts (551) _ Phthalates (606MS)
Res: _i_ mg/L _ Haloacetic Adds (552) Other:_______________^ "
Mbs _ Other Pestiddes (SM18/6630)
__UCMRLt8t1
_MtBE Only (524)
t
BO
IlWALYSiS requested-Lab#:
_ Addity 'J^i^a^num isium
_ jWkallnity />j^timony ilum?
_Bromlde ? ^iJ^enlc -'A
_ Bromate/Chlorate/Chlorite jj/^rium _§odliirri
c:SSSa?U._'o
BOD (5 tiy) .
_CWi»lde j^^rylllum
__ Bpron
t^hallium
'Radium
I -g^Cattrohacebus BOD'-0'day) - Fltic^ ; ,|„,<!<&dmilum ■ Y,.'YY
-L^fl^rtew, Total ae CaCOs _ Calcium, as CaCOs '
& LX Chemical Oxygen Demand :JL Nitrogen, Ammonia as N ___ Calcium, Ca*2
I ; ±-! plsso!ved Oxygen ■ '' \^ NlfrpgM Nitrate as N ' 4„*€!nromlum, Total (^Metals/CN
/ — Total Organic Carbon ..Nitr^enjNitrfteMN' ;i.Vblatil88
.:jjTbtalOr5nlc^«V ?; _ ^romlum, Hexavalent lYSemi^olatlles
Nitrogen. Totai Kjeldahl as N
I ^9sbiiaS,^rtt^(%T'/' :_^OHahd:<Sr6a^W<;-<^' •per
__Pestlclde8/PCB's
I OWifc'SetBeatte^A;? ■__Phenbl? ;?<■>'
'__ ' Solids, Suspended •; __ Phosphorus Total as <
••22; Solids, Total / ■ „TCLP-Metals
_ Phosphorus, Ortho as P
rW ^B^lbtal Dissolved Sulfates : __TCLP-Pesticides .
i_;:Surfactent8 _TCLP-Herbicld6s •
„TCLP-Volatiles
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