NYC 9/11 Public Portal Document
ENVIRONMENTAL SERVICES SAMPLE SUBB^^tON FORM
<com WESTCHESTER COUNTY LABORATORIES AND RESEARCH
2 Dana Road, Valhalla, New York 16595
(914) 231-1620 Fax (914) 231-1772
NYS-ELAPNO/lOlCr
TSme/Date Set; FormA-70 (tev^^0/0l)
circle one):
Wptoble 3. Non Potable Treated Bottte #-8:
^NonPotable 4. Other _ ____________________ Chain of Custody? _YiBS^ No
, Time/Dats Collected: 032X> 3" Comments:
S’
Bv:' Lt . /Agency Code:___ PWS #: ______ __ Source ID: '' l Tyto Descriptor
;j;^l»Bl^.From:. ,■/' Bill to:
■ Lpcation'^lndlvidual's Name MMG Name/Company_„
l Al kp • iv-rve Street
fcosti^p City/St/Zlp____ _
Identification of Source _ ___________ ___________ _ Phone#: > _Fax#:
(Collection Point TSx 1 ___________ _
- I CA.CH. Bl? Y Check#: : Amounts
B BACTERIOLOGICAL ANALYSIS Lab#:
& 'i-atefc- Y._
B’’
ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLID ANALYSIS
HeterotrophlcPlate Count
(hemodialysis & all others) _Irlhalomethan8s (524) __ Purgeable Halocarbons (624/8260)
Ji^olatlie Halocarbons (524) __ Purgeable Aromatics (624/8280)
js^olatile Aromatics (524) _ Acroiein & Acryionitrile (8260) ,
|i Coliform (all samples) __ Total Trihalomethane Potential (510) „Organochlorine Pesticlde8 (608/8081)
^'Microscopic __ Microextractables (504) PCB’s,(Arodilore) (608/8081)
YY Macroscopic __ Pesticides/PCB screen (508) __ Herbicides (SM18/6630,8151)
>_ API . __ PCB as Decachloioblphenyl (508A) __ Other Pesticides {SM18/6630)
^;dther:_^__ __ Herbicides (515) _ Petroleum Hydrocarbon Scan (310-13)
_ Pesticides (525) _ Glycols in Water ? A
yes__ _no __ Carbamate Pesticides (531) __ Acid Extractables (625/8270)
Chlorinated;? _— yes _ no __ Glyphosate (547) „^se Neuttel Extractables (625/8270)
^1^ Chlorine Res:. _______ mg/L _Diquat (549) J^C/MS Unknown Scan
__ Chlorination Disinfection Byproducts (551) Phthalates (606MS)
' Total Chlorine Res: mg/L _Ha!oac8tic Acids (552) 0ther(i__X_:L_L12.__.^.^__..__^
...... __ Other Pesticides (SM18/6630)
_UCMR List 1
S B RAPSCHEMICAL.ANALYSIS _MtBE Only (524)
ANALYSIS REQUESTED - Lab#:
P Y;Color'.-
_ Acidity „Potassium
r-zrr* , __ Alkalinity
__ Bromide:
K.'-
Bromate/Chlorate/Ghlorite
_jb?^tlmony
jurfW^nlc ■
.4>^rlum "
_4,„8^1eniurn
_^dum\ ;
r, Corrosivity (temp:-------- “C) _ Chloride Y ? 4,,H3er^llum .t^K^TOlllum :
__ Cyanide — Boron „ Vanadium
B Carbonaceous:^ (6 toy) Y_ Fluoride f'?
_iX!admium
— Soluble bod __ Hardness, Total as CaCOs __ Calcium, as CaCOa
p YY Chemical Oxygen Demand __ Nitrogen, Ammonia as N _^Ictum, Ca*2 CUE Y.---. ■
E — Dissolved Oxygen' _ Nitrogen, Nitrate as N _uChromlum, Total ,L_Metal8«;N
g i’__ Tptal Organic Carbon __ Nitrogen, Nitrite as N __ Voiatlles •
_ Chromium, Hexavalent ‘
f Organic Halides _ Nitrogen, Total Kjeldahl as N _«$balt _Semi-vlolatlles
Splids,Percent (%)Y Y_ Oli and Grease jXSpper __Pesticides/PCB’s
> — Solids, Settleable ; Phend: •
fSB-j i^to. Suspended ■ Phosphorus Total as P ICLE
l^^g^TeteiY -.H Phosphorus, Ortho as P __ Magnesium _TCLP-Metals
, . -— Solids, Total Dissolved SiilfatesL 4^rtganese „TCLP-Pesticldes ,
Surfactants __TCLP-Herblcldes
_bXercury
’■/‘F'v
Tv J • _4/i0!olybdenum
NYC-WTC_000074976
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