NYC 9/11 Public Portal Document
Nestohester
Ov.com
ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM
WESTCHESTER COUNTY LABORATORIES AND RESEARCH
2 Dana Road, Valhalla, New York 105953
: (914) 231-1620 Fax (914) 231-1772
Time/Date Set:
Sample Type (drde one):
1. Potable
3, Non Potable Treated
2. Non Potable
4. Other
Time/Date Collected:
312
Collected By:_
Collected From:
Location's/individual's Name
Street
City/St/Zip
Identification of Source
Collection Polnt
Agency code: MLWIV
Frdd Blauck
Bottle #s:
Chaln of Custody?-
Comments:
PWS#:
Blll to:
Name/Company
Street
City/StZIp
Phone#:
Yos _ No
Source ID:
CA,CH, BІ?
BACTERIOLOGICAL ANALYSIS
Lab#:
Heterotrophic Plate Count
(hemodialysls & all others)
Coliform P/A (Public supplies)
Collform MPN
(priv well, raw, stp).
Fecal Coliform (all samples)
Microscopic
Macroscopic
API
Other:
Refrigerated?
Chlorinated:?
- yes
_yes
Free Chlorine Res:
Total Chlorine Res:
no
no
mg/L
mg/L
pH
Lab#f;
06S31
ORGANIC POTABLE ANALYSIS
Trihalomethanes (524)
_Volatile Halocarbons (524)
Volatile Aromatics (524)
Total Trihalomethane Potential (510)
Microextractables (504)
Pesticldes/PCB screen (508)
PCB as Decachlorob|phenyl (508A)
Herbicides (515)
Pesticides (525)
Carbamate Pesticides (531)
Glyphosate (547)
Diquat (549)
Chlorination Disinfection Byproducts (551)
Haloacetic Acids (552)
Other Pesticides (SM18/6630)
UCMR List 1
MIBE Only (524)
RADIOCHEMICAL ANALYSIS
Radon
Other
INORGANIC ANALYSIS REQUESTED - Lab#:
_ Color
_ Acidity
. Turbidity
Alkalinity
L pH:
_ Bromide
- Conductivity
- Corrosivity (temp:
°C)
Bromate/Chlorate/Chlorite
.Chloride
- BOD (5 day)
i Cyanide
Carbonaceous BOD (5 day)
Fluoride
Soluble BOD (5 day)
Hardness, Total as CaCO3
. Chemical Oxygen Demand
Nitrogen, Ammonia as N
Dissolved Oxygen
Nitrogen, Nitrate as N
Total Organic Carbon
Nitrogen, Nitrite as N
Total Organic Halides
Nitrogen, Total Kjeldahl as N
:Solids, Percent (%)
Oll and Grease
- Sollds, Settleable
Phenol
- Solids, Suspended
Phosphorus Total as P
Sollds, Total
Phosphorus, Ortho as P
Solids, Total Dissolved
: Solids, Total Volatile
Sulfates
Surfactants
Other
- UV254
Aluminum
Antimony
Arsenic
Barium
,Berylllum
Boron
Cadmlum
Calcium, as CacOs
Calcium, Catzi
Chromium, Total
Chromium, Hexevalent
,Cobalt
Copper
.Iron
,Lead
Magnesium
Manganese
Mercury
.Molybdenum
Nickel
NYC-WTC_000075400
nelr
NYS-ELAP No. 10108
Form A-70 (rev 10/01)
022022
Type Descriptor:
Checkt
- Amounts
ORGANIC NONPOTABLEJ SOLID ANALYSIS
Purgeabie Halocarbons (624/8260)
Purgeable Aromatios (624/8260)
Acrolein & Acrylonitrile (8260)
Organochlorine: Pesticides (608/3081)
PCB's (Arpchlors):(608/8081):
Herpicides (SM16 6630,8151)
Other Pesticfdes (SM18/6630)
Petroleum Hydrocarbon Scan (310-13
Glycols in Water
Add Extractables (625/8270)
Base Neutral Extractables (625/8270)
GC/MS Unknown Soan
Phthalates (606MS)
Others
Potassium
Selenlum
Silver*
- Sodium:
Thallium
Vanadium
Zinç/
_Metals/CN
Volatiles"
→Seml-violatiles
ЩPesticides/PCB's
ICLP
TCLP-Metals
_TCLP-Pesticides
_ TCLP-Herblcides
TCLP-Völatiles
TCLP-BNA's
OCR can misread numbers and units. Confirm readings against the page image before using them.