NYC 9/11 Public Portal Document
ENVIR ENTAL SERVICES SAMPLE SUBMISSION FORM
so. WESTCHESTER COUNTY LABORATORIES AND RESEARCH
2 Dana Road, Valhalla, New York 10595
(914) 231-1620 Fax (914) 231-1772 I S'
N^OAPWHWH
Tme/Date Set: Form A-70 (rev. 10/01)
Sample Type (circle one): # ‘■4 •
A Non Potable Treated
2. Non Potable Chain of Custody? _.Yes__No
Ttee/Dafe Cditetefc,,, Comments:
Collected Agency Code: Source IO: .Type Descriptor
Collected From: ■M
Location’s/! ndividual Name _L Name/Company _
Street / > .
City/St/Zip__L_-_i_ City/St/Zip
identification of Source Phone#:............... Fax#:
Collection Patel
CA,CH.Bi? Check#: Amounts.
BACTERIOLOGICAL ANALYSIS Lab#;
ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLID ANALYSIS
_ Heterotrophic Plate Count
(hemodialysis & all others)
___Trihalomethanes (524) Purgeabte Halocarbons (624/8260)
-Ool»MmRWj^(W*e«PP^
__Coliform MPN (priv well, raw, stp)
_izyolatile Halocarbons (524)
...ZVoiatile Aromatics (524)
_ Purgeable Aromatics (624/8260)
_ Acrolein & Acrylonitrile (8260) .{
_ Fecal Coliform (all samples) __ Total Trihalomethane Potential (510) Organochlorine Pesticides (608/8081) '1
_ Microextractables (504) _ PCB's (Arochlors) (608/8081)
_ Pesticldes/PCB screen (508) _ Herbicides (SM18/6630,8151)
„ PCB as Decachlorobiphenyt (508A) _ Other Pesticides (SM18/6630)
....Other:..... _ .... .... - .. „ Herbicides (515) _ Petroleum Hydrocarbon Scan (310-13)
_ Pesticides (525) __ Glycols in Water
Refrigerated?_ no __ AcidExtractables (625/8270)
Chiorinated:? _ Glyphosate (547) Base Neutral Extractables (625/8270)
_ GC/MS Unknown Scan
Pm Chlorine ..... ..... mc/L ^.Chlorination Disinfection Byproducts (551) _ Phthalates (606MS)
Total Chlorine Res: __Haloacetic Acids (552) _ Other_______ ___ __________ __
_ Other Pesticides(SM18/6630)
_UCMRList1
RADIOCHEMICAL ANALYSIS _„MtBE Only (524)
—Radon
— Other ___________ _
INORGANIC ANALYSIS REQUESTED « Lab#;
— Color
- wl J^uminum _ .Potassium
_Bromide Z^Xrsenic -.Silver
_ Bromate/Chlorate/Chlorite
Corrosivity (tempi
■'tilllilwr __ Chloride _^Beryiiium _j>Jhai!ium
BOD {5 day) Cyanide
_ Carbonaceous BOD (5 day) Fborfefe .^Cadmium — Zinc
Soluble BOD (5 day) Hardness, Total as CaCOs __ Calcium, as CaCO3
__ Chemical Oxygen Demand Nitrogen, Ammonia as N Oa** fete'..
Di^Ned Oxygen Nitrogen, Nitrate as N „Metal^CN
_z<hromium, Total _ Volatiles
__ Total Organic Carbon Nitrogen, Nitrite as N .^Ohroritem, {tosbaMML
Total Organic Halides Nitrogen, Total Kjeldahl asN _kCobait _SwWeiWW
_ {%) _ Pesticides/PCB's
Oil and Grease _±Copper
__ Phenol -Ziron
_ Solids, Suspended __ Phosphorus Total as P _^’Lead _TCLP-Metals
_ Solids, Total Phosphorus. Ortho as P __ Magnesium
_TCLP-Pesficides
_ Solids, Total Dissolved _ Sulfates ^zManganese __TCLP-Herbicides
_.SoIids, Total Volatile Surfactants ..^i^Mercufy _TCLP-VolatHe8
,-4.'oih«i _ UV254 ^.TOLfMWte
NYC-WTC_000075459
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