NYC 9/11 Public Portal Document
ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM
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2 Dana Road, Valhalla, New York 10598 >
(914) 231-1620 Fax (914) 231-1772
RB I*
NYS-ELAP No. 10108
a llme/Date Set V^forrrr^^
TvPbtable 3. Non Poteble Treated
/;2.WPd6abte • ■ 4.Q^r ?Z/ lVe^Chain of Custody? . Yes__ :No
' * tlfne/pate Collected:
.-’CoIlecterl^By:'*^^ : Agency Code: Source ©: Descriptor __
' locaUon'S/lndlvIdual's Name __ .-' Npme/Compeny,
''^Street_________________.____ ' '■ street _______ ‘J ,
’5?
Cltv/Stgip City/St/Zlp
I; Oc<&on
identification of Source __i_Z__
Point , y
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IBAC^mOLOQICALAlM^
ORGANIC POTABLE ANALYSIS
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S'.’
/ (hetwxWye^ a all p»»ra) , _Trihalomethan8s(524)
_VotaaieHalocarbon8 (524)
— Cd^mCPubllC supplies) __ Volatile Atwnattos (524)
__ Coliform MPN (priv well, taw, sip) —i. Aciylonjti
•■^PeeB’CrtWi^ (a» samples) I __TotalTrihalomethane Potential (510) '?^z/’Orri0J5ddifeOTfe^F^
/ „Mlcro8xtractables (504) ; / •
_„Macroscopic .' ‘ / • - __Pe8ttdd^CB8cre8n (508) , - .
&S.
PC0asDecachloroblphenyI(5O8A) / 5f?^^pi0-13)<7/'
__ Other__________ _ _Herbicides (515) \ '
Refrlgerated?__yes no >.:> __Carbamate Pesticides (531) J ;
^qiyphosate (547) -
s ‘ 1*^
3f»,.
isssss:3.a:
:.fng/L
__ChloriS?on Dtslnfe^on Byprodtjcts" (551)
__Haioac8tio Adds/ (552) , wiKa® s ..
_OthQrPesticlde8(SM18/6630) . j*
_UCMRList 1 'r./v
Br IS—EZTS I
M
ISO
f-9!a6«»-»3gasS«*^BWsi
s
t'
S' ifeiiK?!? h
:-»3
z Z Nitrogen.
XTNitrate aXS'^T ■' ■ -'Ri
i _ Dlssolwed Qt^en
_ Total Organic Carbon
........
Total Organie HaW«» .
as N
_ Nitrogen, Nitrite as N
_Nftr6gert,.TWl^ahiasN
.v^^wm^otetf
_ Chromium, Hexavalent '
^CN
1^' . '
‘
^^SQ|ld8) P^ (%)
,^;-Sdli(|^p^e,
_ Solld8, SuspendQd - ■
_ Solids, Total
■; _j.OllantJGr0as8
, __
’ — PhosphorusTote! as P
_ Phosphorus, Ortho as P
•./• -S*
A*;; o
_<WdSrWtWved
__,Soltds,Tbtal Volatile^ __ Surfactants '" -S^ercury
iZOther: __UV254 _TCLP-Vo{atil0s
j^Ntek^ ; _TCLP-^N/&
NYC-WTC_000075304
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