Form 109 - Wadsworth Center
Form 109 - Wadsworth Center
Form 109 - Wadsworth Center
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Please complete and return to:<br />
New York State Department of Health<br />
<strong>Wadsworth</strong> <strong>Center</strong> - Environmental Laboratory Approval Program<br />
Complete if applicable<br />
PO Box 509 - Empire State Plaza<br />
Albany, New York 12201-0509 Lab ID # _______________<br />
Phone: 518-485-5570 Fax: 518-485-5568 e-mail: elap@health.state.ny.us<br />
Laboratory Name:<br />
Number Street:<br />
City, State, Zip:<br />
APPLICATION for PRIMARY ACCREDITATION - NON-POTABLE WATER<br />
If New York ELAP is your laboratory's primary NELAC accreditor, you must include the following for each analyte for which approval is<br />
requested: ____ Demonstration of Capability (DOC) form, ____ DOC summary/supporting data, and ____ Standard Operating Procedure.<br />
To complete this form, please place an "A" in the line preceding each analyte name to indicate an addition to your scope of accreditation.<br />
If you wish to remove an analyte from your scope, place an "E" in the space preceding each analyte name. Also, please cite the<br />
determinant and/or prep method you wish to add or erase by using the "ELAP Method Number" listed in Certification Manual Item 180.2.<br />
For example, cite Barium by EPA 6020 and EPA 3010A as "4065" and "4015".<br />
An application that omits any of this information will be considered imcomplete.<br />
Is the application request for additions ("A") for NYS work (i.e, will analysis be performed on NYS samples)? ___ Y ___ N<br />
Demand<br />
Residue<br />
Biochemical Oxygen Demand<br />
Carbonaceous BOD<br />
Chemical Oxygen Demand<br />
Settleable Solids<br />
Solids, Total Dissolved<br />
Solids, Total Suspended<br />
Solids, Total<br />
Bacteriology<br />
Mineral<br />
Coliform, Fecal<br />
Standard Plate Count<br />
Coliform, Total<br />
Enterococci<br />
E. coli (Enumeration)<br />
Acidity<br />
Alkalinity<br />
Chloride<br />
Fluoride, Total<br />
Calcium Hardness<br />
DOH-<strong>109</strong> (05/03/12) -1-<br />
ELAP Method No. ELAP Method No.<br />
Nutrient<br />
Hardness, Total<br />
Sulfate (as SO4)<br />
Ammonia (as N)<br />
Kjeldahl Nitrogen, Total<br />
Nitrate (as N)<br />
Nitrite (as N)<br />
Orthophosphate (as P)<br />
Phosphorus, Total<br />
Wastewater Metals I<br />
Barium, Total<br />
Cadmium, Total<br />
Calcium, Total<br />
Chromium, Total<br />
Copper, Total<br />
Iron, Total<br />
Lead, Total<br />
Magnesium, Total<br />
Manganese, Total<br />
Nickel, Total<br />
Potassium, Total<br />
Silver, Total
Sodium, Total<br />
Strontium, Total<br />
Wastewater Metals II<br />
Aluminum, Total<br />
Antimony, Total<br />
Arsenic, Total<br />
Beryllium, Total<br />
Chromium VI<br />
Mercury, Total<br />
Mercury, Low Level<br />
Selenium, Total<br />
Vanadium, Total<br />
Zinc, Total<br />
Wastewater Metals III<br />
Acrylates<br />
Cobalt, Total<br />
Gold, Total<br />
Molybdenum, Total<br />
Palladium, Total<br />
Platinum, Total<br />
Thallium, Total<br />
Tin, Total<br />
Titanium, Total<br />
Uranium (Mass)<br />
Acrolein (Propenal)<br />
Acrylonitrile<br />
Ethyl methacrylate<br />
Methyl acrylonitrile<br />
Methyl methacrylate<br />
Benzidines<br />
Benzidine<br />
3,3'-Dichlorobenzidine<br />
3,3'-Dimethylbenzidine<br />
Chlorinated Hydrocarbons<br />
1-Chloronaphthalene<br />
2-Chloronaphthalene<br />
Hexachlorobenzene<br />
Hexachlorobutadiene<br />
Hexachloroethane<br />
Hexachlorocyclopentadiene<br />
Hexachloropropene<br />
DOH-<strong>109</strong> (05/03/12) -2-<br />
ELAP Method No. ELAP Method No.<br />
Dioxins<br />
Pentachlorobenzene<br />
1,2,4-Trichlorobenzene<br />
1,2,3-Trichlorobenzene<br />
1,2,4,5-Tetrachlorobenzene<br />
2,3,7,8-Tetrachlorodibenzo-p-dioxin<br />
Haloethers<br />
Bis(2-chloroethyl)ether<br />
Bis (2-chloroisopropyl) ether<br />
Bis(2-chloroethoxy)methane<br />
4-Chlorophenylphenyl ether<br />
4-Bromophenylphenyl ether<br />
Nitroaromatics and Isophorone<br />
1,3-Dinitrobenzene<br />
1,3,5-Trinitrobenzene<br />
1,4-Naphthoquinone<br />
2-Amino-4,6-dinitrotoluene<br />
2-Nitrotoluene<br />
3-Nitrotoluene<br />
4-Nitrotoluene<br />
4-Amino-2,6-dinitrotoluene<br />
2,4-Dinitrotoluene<br />
2,6-Dinitrotoluene<br />
3,5-Dinitroaniline<br />
Hexahydro-1,3,5-trinitro-1,3,5-triazine<br />
Isophorone<br />
2,4,6-Trinitrotoluene<br />
Methyl-2,4,6-trinitrophenylnitramine<br />
Nitrobenzene<br />
Nitroglycerine<br />
Nitroquinoline-1-oxide<br />
Octahydro-tetranitro-tetrazocine<br />
Pentaerythritol tetranitrate<br />
Nitrosoamines<br />
N-Nitrosodiethylamine<br />
N-Nitrosodimethylamine<br />
N-Nitrosodiphenylamine<br />
N-Nitrosodi-n-butylamine<br />
N-nitrosomethylethylamine<br />
N-nitrosomorpholine<br />
N-Nitrosodi-n-propylamine<br />
N-nitrosopiperidine
N-Nitrosopyrrolidine<br />
Phthalate Esters<br />
Benzyl butyl phthalate<br />
Bis(2-ethylhexyl) phthalate<br />
Diethyl phthalate<br />
Dimethyl phthalate<br />
Di-n-butyl phthalate<br />
Di-n-octyl phthalate<br />
Polychlorinated Biphenyls<br />
PCB-1016<br />
PCB-1221<br />
PCB-1232<br />
PCB-1242<br />
PCB-1248<br />
PCB-1254<br />
PCB-1260<br />
PCB-1262<br />
PCB-1268<br />
2-Chlorobiphenyl<br />
2,2'-Dichlorobiphenyl<br />
2,2',3,4,4',5'-Hexachlorobiphenyl<br />
2,2',3,4,4',5,5'-Heptachlorobiphenyl<br />
2,2',3,4,4',5',6-Heptachlorobiphenyl<br />
2,2',3,4,4',6,6'-Heptachlorobiphenyl<br />
2,2',3,4',5,5',6-Heptachlorobiphenyl<br />
2,2',3,3',4,5,5',6,6'-Nonachlorobiphenyl<br />
2,2',3,3',4,4',5,5',6-Nonachlorobiphenyl<br />
2,2',3,3',4,4'-Hexachlorobiphenyl<br />
2,2',3,3',4,4',5-Heptachlorobiphenyl<br />
2,2',3,3',5,5',6,6'-Octachlorobiphenyl<br />
2,3,3',4,4',5-Hexachlorobiphenyl<br />
2,2',3,4,5,5'-Hexachlorobiphenyl<br />
2,2',3,4,5'-Pentachlorobiphenyl<br />
2,2',3,4',5,6,6'-Heptachlorobiphenyl<br />
2,2',3,5,5',6-Hexachlorobiphenyl<br />
2,2',3,5'-Tetrachlorobiphenyl<br />
2,4',5-Trichlorobiphenyl<br />
2,2',4,4',5,5'-Hexachlorobiphenyl<br />
2,2',4,5,5'-Pentachlorobiphenyl<br />
2,2',4,4',6,6'-Hexachlorobiphenyl<br />
2,2',4,6,6'-Pentachlorobiphenyl<br />
2,2',5-Trichlorobiphenyl<br />
2,2',5,5'-Tetrachlorobiphenyl<br />
DOH-<strong>109</strong> (05/03/12) -3-<br />
ELAP Method No. ELAP Method No.<br />
2,2',6-Trichlorobiphenyl<br />
2,2',6,6'-Tetrachlorobiphenyl<br />
2,3-Dichlorobiphenyl<br />
2,3',4,4',5,5'-Hexachlorobiphenyl<br />
2,3,3',4,4',5'-Hexachlorobiphenyl<br />
2,3,3',4,4',5,5'-Heptachlorobiphenyl<br />
2,3,3',4,6-Pentachlorobiphenyl<br />
2,3,3',4,4'-Pentachlorobiphenyl<br />
2,3,3',4,4',5,5',6-Octachlorobiphenyl<br />
2,2,',3,3,'4,4',5,6-Octachlorobiphenyl<br />
2,3',4,4'-Tetrachlorobiphenyl<br />
2,3,4,4',5-Pentachlorobiphenyl<br />
2,3',4,4',5-Pentachlorobiphenyl<br />
2,3',4,4',5'-Pentachlorobiphenyl<br />
2,4'-Dichlorobiphenyl<br />
2,4,4'-Trichlorobiphenyl<br />
2,2',4,5'-Tetrachlorobiphenyl<br />
3,4,4'-Trichlorobiphenyl<br />
3,4,4',5-Tetrachlorobiphenyl<br />
3,3',4,4'-Tetrachlorobiphenyl<br />
3,3',4,5,5'-Pentachlorobiphenyl<br />
3,3',4,4',5-Pentachlorobiphenyl<br />
3,3',4,4',5,5'-Hexachlorobiphenyl<br />
4,4'-Dichlorobiphenyl<br />
4-Chlorobiphenyl<br />
Decachlorobiphenyl<br />
Polynuclear Aromatics<br />
2-Acetylaminofluorene<br />
Acenaphthene<br />
Anthracene<br />
Acenaphthylene<br />
Benzo(a)anthracene<br />
Benzo(a)pyrene<br />
Benzo(b)fluoranthene<br />
Benzo(ghi)perylene<br />
Benzo(k)fluoranthene<br />
Chrysene<br />
Dibenzo(a,h)anthracene<br />
7,12-Dimethylbenzyl (a) anthracene<br />
Fluoranthene<br />
Fluorene<br />
Indeno(1,2,3-cd)pyrene<br />
Naphthalene<br />
3-Methylcholanthrene
Phenanthrene<br />
Pyrene<br />
Low Level Polynuclear Aromatics<br />
Acenaphthene<br />
Acenaphthylene<br />
Anthracene<br />
Benzo(a)anthracene<br />
Benzo(b)fluoranthene<br />
Benzo(k)fluoroanthene<br />
Benzo(g,h,i)perylene<br />
Benzo(a)pyrene<br />
Chrysene<br />
Dibenzo(a,h)anthracene<br />
Fluoranthene<br />
Fluorene<br />
Indeno(1,2,3-cd)pyrene<br />
Naphthalene<br />
Phenanthrene<br />
Pyrene<br />
Priority Pollutant Phenols<br />
4-Chloro-3-methylphenol<br />
2-Chlorophenol<br />
2,4-Dichlorophenol<br />
2,6-Dichlorophenol<br />
2,4-Dimethylphenol<br />
2,4-Dinitrophenol<br />
2-Methyl-4,6-dinitrophenol<br />
2-Nitrophenol<br />
4-Nitrophenol<br />
2-Methylphenol<br />
3-Methylphenol<br />
4-Methylphenol<br />
Cresols, Total<br />
Pentachlorophenol<br />
Phenol<br />
2,3,4,6 Tetrachlorophenol<br />
2,4,5-Trichlorophenol<br />
2,4,6-Trichlorophenol<br />
Volatile Aromatics<br />
1,2,4-Trichlorobenzene, Volatile<br />
Benzene<br />
Bromobenzene<br />
DOH-<strong>109</strong> (05/03/12) -4-<br />
ELAP Method No. ELAP Method No.<br />
Chlorobenzene<br />
1,2-Dichlorobenzene<br />
1,3-Dichlorobenzene<br />
1,4-Dichlorobenzene<br />
1,2,4-Trimethylbenzene<br />
1,3,5-Trimethylbenzene<br />
2-Chlorotoluene<br />
4-Chlorotoluene<br />
Ethyl benzene<br />
Isopropylbenzene<br />
Naphthalene, Volatile<br />
n-Butylbenzene<br />
n-Propylbenzene<br />
p-Isopropyltoluene (P-Cymene)<br />
Toluene<br />
Total Xylenes<br />
sec-Butylbenzene<br />
tert-Butylbenzene<br />
Styrene<br />
Volatile Halocarbons<br />
Bromochloromethane<br />
Bromodichloromethane<br />
Bromoform<br />
Bromomethane<br />
Carbon tetrachloride<br />
Chloroethane<br />
2-Chloro-1,3-butadiene (Chloroprene)<br />
2-Chloroethylvinyl ether<br />
Chloroform<br />
Chloromethane<br />
3-Chloropropene (Allyl chloride)<br />
Dibromochloromethane<br />
Dibromomethane<br />
Dichlorodifluoromethane<br />
cis-1,4-Dichloro-2-butene<br />
trans-1,4-Dichloro-2-butene<br />
1,1-Dichloroethane<br />
1,2-Dichloroethane<br />
1,1-Dichloroethene<br />
cis-1,2-Dichloroethene<br />
trans-1,2-Dichloroethene<br />
1,1-Dichloropropene<br />
1,2-Dichloropropane<br />
1,3-Dichloropropane
2,2-Dichloropropane<br />
trans-1,3-Dichloropropene<br />
cis-1,3-Dichloropropene<br />
1,2-Dibromo-3-chloropropane<br />
1,2-Dibromoethane<br />
Hexachlorobutadiene, Volatile<br />
Methylene chloride<br />
Methyl iodide<br />
1,1,1,2-Tetrachloroethane<br />
1,1,2,2-Tetrachloroethane<br />
Tetrachloroethene<br />
1,1,1-Trichloroethane<br />
1,1,2-Trichloroethane<br />
Trichloroethene<br />
Trichlorofluoromethane<br />
1,2,3-Trichloropropane<br />
1,2-Dichloro-1,1,2-Trifluoroethane<br />
1,1,2-Trichloro-1,2,2-Trifluoroethane<br />
Vinyl chloride<br />
Chlorinated Hydrocarbon Pesticides<br />
Aldrin<br />
alpha-BHC<br />
beta-BHC<br />
delta-BHC<br />
Lindane<br />
Captan<br />
alpha-Chlordane<br />
gamma-Chlordane<br />
Chlordane Total<br />
Chlorobenzilate<br />
4,4'-DDD<br />
4,4'-DDE<br />
4,4'-DDT<br />
Diallate<br />
Dieldrin<br />
Dichloran<br />
Dicofol<br />
Endosulfan I<br />
Endosulfan II<br />
Endosulfan sulfate<br />
Endrin<br />
Endrin aldehyde<br />
Endrin Ketone<br />
Heptachlor<br />
DOH-<strong>109</strong> (05/03/12) -5-<br />
ELAP Method No. ELAP Method No.<br />
Heptachlor epoxide<br />
Isodrin<br />
Kepone<br />
Mirex<br />
Methoxychlor<br />
PCNB<br />
Perthane<br />
Strobane<br />
Trifluralin<br />
Toxaphene<br />
Chlorophenoxy Acid Pesticides<br />
2,4-D<br />
2,4-DB<br />
Dalapon<br />
Dicamba<br />
Dichloroprop<br />
Dinoseb<br />
2,4,5-T<br />
2,4,5-TP (Silvex)<br />
Organophosphate Pesticides<br />
Atrazine<br />
Azinphos methyl<br />
Chlorpyriphos<br />
Cyanizine<br />
Diazinon<br />
Disulfoton<br />
Demeton-O<br />
Demeton-S<br />
Dimethoate<br />
Famphur<br />
Isophenphos<br />
Malathion<br />
Parathion ethyl<br />
Parathion methyl<br />
Pendimethalin<br />
Phorate<br />
Prometon<br />
Prometryn<br />
Simazine<br />
Thionazin<br />
Volatile Chlorinated Organics<br />
Benzyl chloride
Epichlorohydrin<br />
Radiological Analytes<br />
Gross Alpha<br />
Gross Beta<br />
Photon Emitters<br />
Radioactive Cesium<br />
Iodine-131<br />
Plutonium<br />
Radium-226<br />
Radium-228<br />
Radon<br />
Strontium-89<br />
Strontium-90<br />
Tritium<br />
Uranium (Activity)<br />
Wastewater Miscellaneous<br />
Amines<br />
Turbidity<br />
Boron, Total<br />
Bromide<br />
Color<br />
Corrosivity<br />
Cyanide, Available<br />
Cyanide, Total<br />
<strong>Form</strong>aldehyde<br />
Oil & Grease Total Recoverable (HEM)<br />
Organic Carbon, Total<br />
Perchlorate<br />
Phenols<br />
Silica, Dissolved<br />
Specific Conductance<br />
Surfactant (MBAS)<br />
Sulfide (as S)<br />
Total Organic Halides<br />
Total Petroleum Hydrocarbons<br />
Aniline<br />
4-Chloroaniline<br />
a,a-Dimethylphenethylamine<br />
1-Naphthylamine<br />
1,2-Diphenylhydrazine<br />
2,3-Dichloroaniline<br />
2-Naphthylamine<br />
DOH-<strong>109</strong> (05/03/12) -6-<br />
ELAP Method No. ELAP Method No.<br />
2-Nitroaniline<br />
3-Nitroaniline<br />
4-Nitroaniline<br />
4,4'-Methylenebis(2-chloroaniline)<br />
5-Nitro-o-toluidine<br />
Carbazole<br />
Diphenylamine<br />
Methapyrilene<br />
1,4-Phenylenediamine<br />
Pronamide<br />
Propionitrile<br />
Pyridine<br />
Volatiles Organics<br />
Acetone<br />
Acetonitrile<br />
2-Butanone (Methylethyl ketone)<br />
Carbon Disulfide<br />
Cyclohexane<br />
Di-ethyl ether<br />
1,4-Dioxane<br />
Ethyl Acetate<br />
Ethylene Glycol<br />
Isopropanol<br />
Isopropyl Acetate<br />
Methyl acetate<br />
n-Amyl Acetate<br />
n-Butanol<br />
n-Butyl Acetate<br />
2-Hexanone<br />
Isobutyl alcohol<br />
Methyl cyclohexane<br />
4-Methyl-2-Pentanone<br />
2-Nitropropane<br />
o-Toluidine<br />
Vinyl acetate<br />
Ethylene thiourea<br />
Semi-Volatile Organics<br />
Acetophenone<br />
alpha-Terpineol<br />
4-Amino biphenyl<br />
Aramite<br />
Benzoic Acid<br />
Benzyl alcohol
Benzaldehyde<br />
1,1'-Biphenyl<br />
Caprolactam<br />
1,2-Dichlorobenzene, Semi-volatile<br />
1,3-Dichlorobenzene, Semi-volatile<br />
1,4-Dichlorobenzene, Semi-volatile<br />
Dibenzofuran<br />
p-Dimethylaminoazobenzene<br />
Ethyl methanesulfonate<br />
Isosafrole<br />
Methyl methanesulfonate<br />
2-Methylnaphthalene<br />
n-Decane<br />
n-Octadecane<br />
2-Picoline<br />
Phenacetin<br />
Safrole<br />
O,O,O-Triethyl phosphorothioate<br />
Carbamate Pesticides<br />
Aldicarb Sulfone<br />
Aldicarb Sulfoxide<br />
Aldicarb<br />
Carbofuran<br />
Carbaryl<br />
Fuel Oxygenates<br />
Di-isopropyl ether<br />
Ethanol<br />
tert-butyl ethyl ether (ETBE)<br />
Methyl tert-butyl ether<br />
tert-amyl alcohol<br />
tert-amyl methyl ether (TAME)<br />
tert-butyl alcohol<br />
Dissolved Gases<br />
Acetylene<br />
Ethane<br />
Ethene (Ethylene)<br />
Methane<br />
Propane<br />
Petroleum Hydrocarbons<br />
Diesel Range Organics<br />
Gasoline Range Organics<br />
DOH-<strong>109</strong> (05/03/12) -7-<br />
ELAP Method No. ELAP Method No.
ELAP Method No. ELAP Method No.<br />
Are any of the additions or erasures requested on this form associated with State and/or Federal contracts? ____ yes ____ no<br />
I certify that the environmental laboratory analyses in the Non-Potable Water category for which approval has been requested are done<br />
using methods approved by the Commissioner of Health and that the information in this application is true to the best of my knowledge.<br />
NAME OF LABORATORY DIRECTOR SIGNATURE OF LABORATORY DIRECTOR MO / DAY/ YEAR<br />
DOH-<strong>109</strong> (05/03/12) -8-
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