NYC 9/11 Public Portal Document
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VENVIRONMENTAL SÉRVICES SAMPLE SUBMISSION FORM
WESTCHESTER COUNTY LABORATORIES AND RESEARCH
2 Dana
Road, Valhalla, New York 10595
(914) 231-1620 Fax (914) 231-1772
Time/Date Set:
Sample Type (circie one):
dPotable*
3. Non Potable Treated
32 Non Potable
4. Other
/Time/Date Collectec:
912 am
Colleécted By. B. Gertsik
Collected From:
Locatton's/Individuat'e Nemea2
Street
City/SUZip
identification of Source
Collection Point
44750
3/15/02
Agency Code:
08288
nehc
NYS-ELAP No. 10108
Form A-70 (rev.10/01)
Bottle #s:
0112, 3260, 3040, 423, 2162
Chain of Custody?
* YeS _NO
Comments:
PWS #:
Source ID: L
Type Descriptor:
Bill to:
Name/Company ae
Street
City/St/Zip
Phone#:
Fax#:
CA,CH, ВІ?
Check#:
Amount$
BACTERIOLOGICAL ANALYSIS
Lab#:
Lab#:
Heterotrophic Plate Count
(hemodlalysis & all others)
Collform PIA (Publle supplles)
Coliform MPN (priv well, raw, stp)
Fecal Coliform (all samples)
Microscopic
Macroscopic
APIR
_ Other;
Refrigerated?
yes
Chlorinated:?
yes
Free Chiorine Res:
Total Chlorine Res:
no
no
mg/L
mg/L
pH
ORGANIC POTABLE ANALYSIS
_Trihalomethanes (524)
= Volatile Halocarbons (524):
Volatile Aromatics (524)
Total Trihalomethane Potential (510)
Microextractables (504)
Pesticides/PCB screen (508)
PCB as Decachlorobiphenyl (508A)
Herbicides (515)
Pesticldes (525)
Carbamate Pesticides (531)
Glyphosäte (547):
Diquat (549)
_ Chlorination Disinfection Byproducts (551)
Haloacetic Acids (552)
Other Pesticides (SM18/6630)
UCMR List 1
MtBE Only (524)
ORGANIC NONPOTABLE/SOLID ANALYSIS
Purgeable Halocarbons (624/8260)
• Purgeable Aromatics: (624/8260)
- Acrolein & 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)
LGC/MS Unknown Scan
Phthalates (606MS)
"Other:
RADIOCHEMICAL ANALYSIS
Radon
Other
INORGANIC ANALYSIS REQUESTED - Lab#:
_ Color
Turbidity
Conductlvity
Corrosivity (temp
°C).
BOD (5 day)
Carbonaceous BOD (5 day)
Soluble BOD (5 day)
Chemical Oxygen Demand
Dissolved Oxygen
Total Organic Carbon
Total Organic Halides
Solids, Percent (%)
Solids, Settleable
Solids, Suspended
Sollds, Total
Solids, Total Dissolved
Solids, Totel Volatile
LOther:
Acidity
Alkalinity
1 Bromide
Bromate/Chlorate/Chlorite
Chloride
Cyanide
Fluoride
Hardness, Total as CaCO3
Nitrogen, Ammonia as N
- Nitrogen, Nitrate as N
Nitrogen, Nitrite as N
Nitrogen, Total Kjeldahl as N
Oll and Grease
:Phenol
Phosphorus Total as P
Phosphorus, Ortho as P
Sulfates
Surfactants
UV254
06454
Aluminum
YAntimony
Arsenic
V Barium
W Beryllium
Boron
Cadmium
- Calcium, as CaCOs
Calcium, Ca+2
EChromium, Total
Chromium, Hexavalent
kCobalt
* Copper
Liron
KLead
-
Magnesium
LManganese
L Mercury
* Molyiplenum
w Nickel
Potassium
&Selenlum
silver
Sodlum
Le Thallium
Vanadium
Izina a
CLP
_Metals/CN
Volatiles
Seml-violatiles
Pesticldes/PCB's
ICLP
_TCLP-Metals
TCLP-Pesticides
- TCLP-Herbicides
TCLP-Volatiles
:TCLP-BNA's
NYC-WTC_000075372
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