NYC 9/11 Public Portal Document
Westchester
ov.com
ENVIRONMENTAL SERVICES SAMPLE SUBMISSIÖN FORM
WESTCHESTER COUNTY LABORATORIES AND RESEARCH
2 Dana Road, Valhalla, New York 10595
. (914) 231-1620. Fax (914) 231-1772
Time/Date Set:
INYS-ELAP No 10108
Form A-70 (rev 10/01)
Sample Type (clicle one):
i1. Potable
•3. Non Potable Treated
2 Non Potable
4.Other
Time/Date Collected:
Collected By:
Cab
Collected From:
Location's/Individual's Name
Street
City/StZlp
Identification of Source
Collection Point
Agency code LENt
eld Blank
Bottle #s:
U 3078
Chain of Custody?
Yes
_No
Comments:
PWS#:
Source ID:
Bill to:
:Name/Company
Street
City/St/Zip
Phone#
CA,CH, BI?
Check#:_
57
P1O49
34
Type Descriptor:
Fax#:
-Amouat
BACTERIOLOGICAL ANALYSIS
Lab#::
Heterotrophic Plate Count
(hemodialysis & all others)
Coliform P/A" (Public supplies)
Collform MPN
(priv well, raw, stp)
,Fecal Colfform (all sampies)
Microscopic
Macroscopic
APL
L Other:
Refrigerated?
,yes
no
Chiorinated:?
Free Chlorine Res
Total Chlorine Res:
mg/L
mg/L
pH
RADIOCHEMICAL ANALYSIS
Lab#:
ORGANIC POTABLE ANAL
-Trhalomethanes (524)
Völatile Halocarbons (524)
Volatile Aromatics (524)
.Total Trihalomethane Potential (510)
Microextractables (504)
Pesticides/PCB screen (508)
PCB as Decachlorobiphenyi (508A)
Herbicides (515)
Pesticides (525)
¿Carbamate Pesticides (531)
:Glyphosate (547)
Diquat (549)
_Chlorination Disinfection Byproducts (551)
:Haloacetic Acids (552)
:Other Pesticides (SM18/6630)
EUCMR List 1
#MIBE Only (524)
Radon
:Other
INORGANIC ANALYSIS REQUESTED- Lab#
Acidity
Turbidity
pH
"Alkallnity
2L-Bromide
sinim
Conductivity
_ Bromate/Chlorate/Chlorite
Corrosivity (temp:
°C)
, Chloride
BOD (5 'day)
Cyanide
Carbonaceous BOD (5 day)
Fluoride
1 Soluble BOD. (5 day)
Hardness, Total as CạCO3
1 Chemical Oxygen Demand
Nitrogen, Ammonla as N
Dissolved Oxygen
Nitrogen, Nitrate as N
•Total Organlc Carbon
Nitrogen, Nitrite as N
:Total Organic Halides
Nitrogen, Total Kjeldahl as N
Solids, Percent (%)
Oll and Grease
, Solids, Settieable
Solids, Suspended
Phenol
s Phosphorus Total as P
= Sollds, Total
Phosphorus, Ortho as P
Solids, Total Dissolved
¿Sulfates
Solids, Total Volatile
Surfactants
in ii
Other:
LUV254
ORGANIC NONPOTABLE/SOUD ANALYSIS
Purgeable Halocarbons (62418260)
Purgeable Aromatics (624/8260)
Acrolein & Acryionitrile (8260)
Organochlorine Posticides (608/8081)
PCB's (Arochlors) (608/8081)
Herbicides (SM18/6630,8151)
Other Pesticides (SM18/6630)
Petroleum Hydrocarbon Scan (310-15
Glycols In Water:
Acid Extráctableis (625/8270)
Base Neutral Extractables (625/8270)
GC/MS Unknown Scan
Phthalates (606MS)
Other:
Aluminum
_Antimony
Arsenic
- Barlüm
_ Beryliium
Boron
_Cadmium
_ Caldum, as CaCOs
Calclum, Catz !
_Chromium, Totat
-Chromlum, Hexavalent
_:Cobalt
Copper
-tron
Lead
_Magneslum
_ Manganese
_ Mercury
Molybdenum
E Nickel
Zinc
ICLP
TCLP-Metals
-
.TCLP-Pesticides
1TCLP-Herblcides
_ TCLP-Volatiles
TCLP-BNA'S
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