Please complete and return to: New York State Department of Health Wadsworth Center - Environmental Laboratory Approval Program PO BOX 509 - Empire State Plaza Albany, NY 12201-0509 Phone: (518) 485-5570 Fax: (518) 473-8117 email: elap@health.ny.gov Complete if Applicable: LAB ID# Laboratory Name: Address: City.State, Zip: APPLICATION for PRIMARY ACCREDITATION - SOLID AND CHEMICAL MATERIALS 180.3 If New York ELAP is your laboratory's primary NELAC accreditor, you must include the following for each analyte for which approval is requested: Demonstration of Capability (DOC) form, DOC summary/supporting data, and Standard Operating Procedure To complete this form, please place an "A" on the line preceding each analyte name to indicate an addition to your scope of accreditation. If you wish to remove an analyte from your scope, place an "E" on the line preceding each analyte name. Also, please cite the determinant and/or prep method you wish to add or erase by using the "ELAP Method Number" listed in the Certification Manual Item 180.3. For example, cite PCB-1016 by GC-ECD using EPA 8082A and EPA 3550C as "4308" and "4051". An application that omits any of this information will be considered incomplete. Is the application request for additions ("A") for NYS work (i.e. will analysis be performed on NYS samples)? Y N Does your lab wish to participate in NYS DOH PT studies for those fields of accreditation that have a PT requirement? Y N Characteristic Testing Ignitability Corrosivity E.P. Toxicity TCLP Synthetic Precipitation Leaching Proc. Multiple Extraction Procedure Free Liquids Metals I Barium, Total Cadmium, Total Calcium, Total Chromium, Total Copper, Total Iron, Total Lead, Total Nickel, Total Magnesium, Total Manganese, Total Potassium, Total Silver, Total Sodium, Total Metals I Strontium, Total Metals II Aluminum, Total Antimony, Total Arsenic, Total Beryllium, Total Chromium VI Lithium, Total Mercury, Total Selenium, Total Vanadium, Total Zinc, Total Metals III Cobalt, Total Molybdenum, Total Thallium, Total Tin, Total Titanium, Total Silica, Dissolved Acrylates Acrolein (Propenal) -1-
Acrylates Acrylonitrile Ethyl methacrylate Methyl acrylonitrile Methyl methacrylate Chlorinated Hydrocarbons 1-Chloronaphthalene 2-Chloronaphthalene Hexachlorobenzene Hexachlorobutadiene Hexachlorocyclopentadiene Hexachloroethane Hexachlorophene Hexachloropropene Pentachlorobenzene 1,2,3-Trichlorobenzene 1,2,4-Trichlorobenzene 1,3,5-Trichlorobenzene 1,2,4,5-Tetrachlorobenzene Haloethers Bis(2-chloroethyl)ether Bis(2-chloroethoxy)methane 2,2'-Oxybis(1-chloropropane) 4-Bromophenylphenyl ether 4-Chlorophenylphenyl ether Chloromethylmethyl ether Nitroaromatics and Isophorone 2-Amino-4,6-dinitrotoluene 4-Amino-2,6-dinitrotoluene 3-Chloromethyl pyridine-hcl 4-Dimethylaminoazobenzene 2,4-Dinitrotoluene 2,6-Dinitrotoluene 3,5-Dinitroaniline 1,2-Dinitrobenzene 1,3-Dinitrobenzene 1,4-Dinitrobenzene Hexahydro-1,3,5-trinitro-1,3,5-triazine Hydroquinone Isophorone Methyl-2,4,6-trinitrophenylnitramine 1,4-Naphthoquinone Nitroaromatics and Isophorone 4-Nitroquinoline-1-oxide 2-Nitrotoluene 3-Nitrotoluene 4-Nitrotoluene Nitrobenzene Nitroglycerine Octahydro-tetranitro-tetrazocine Pentaerythritol tetranitrate Pyridine 1,3,5-Trinitrobenzene 2,4,6-Trinitrotoluene 2,4,6-Trichloronitrobenzene Phthalate Esters Benzyl butyl phthalate Bis(2-ethylhexyl) phthalate Diethyl phthalate Dimethyl phthalate Di-n-butyl phthalate Di-n-octyl phthalate PCB-1016 PCB-1221 PCB-1232 PCB-1242 PCB-1248 PCB-1254 PCB-1260 PCB-1262 PCB-1268 PCBs in Oil PCB 1 PCB 2 PCB 3 PCB 4 PCB 5 PCB 6 PCB 7 PCB 8 PCB 9 PCB 10 PCB 11 PCB 12-2-
PCB 13 PCB 54 PCB 55 PCB 14 PCB 56 PCB 15 PCB 57 PCB 16 PCB 58 PCB 17 PCB 59 PCB 18 PCB 60 PCB 19 PCB 61 PCB 20 PCB 62 PCB 21 PCB 63 PCB 22 PCB 64 PCB 23 PCB 65 PCB 24 PCB 66 PCB 25 PCB 67 PCB 26 PCB 68 PCB 27 PCB 69 PCB 28 PCB 70 PCB 29 PCB 71 PCB 30 PCB 72 PCB 31 PCB 73 PCB 32 PCB 74 PCB 33 PCB 75 PCB 34 PCB 76 PCB 35 PCB 77 PCB 36 PCB 78 PCB 37 PCB 79 PCB 38 PCB 80 PCB 39 PCB 81 PCB 40 PCB 82 PCB 41 PCB 83 PCB 42 PCB 84 PCB 43 PCB 85 PCB 44 PCB 86 PCB 45 PCB 87 PCB 46 PCB 88 PCB 47 PCB 89 PCB 48 PCB 90 PCB 49 PCB 91 PCB 50 PCB 92 PCB 51 PCB 93 PCB 52 PCB 94 PCB 53-3-
PCB 95 PCB 136 PCB 137 PCB 96 PCB 138 PCB 97 PCB 139 PCB 98 PCB 140 PCB 99 PCB 141 PCB 100 PCB 142 PCB 101 PCB 143 PCB 102 PCB 144 PCB 103 PCB 145 PCB 104 PCB 146 PCB 105 PCB 147 PCB 106 PCB 148 PCB 107 PCB 149 PCB 108 PCB 150 PCB 109 PCB 151 PCB 110 PCB 152 PCB 111 PCB 153 PCB 112 PCB 154 PCB 113 PCB 155 PCB 114 PCB 156 PCB 115 PCB 157 PCB 116 PCB 158 PCB 117 PCB 159 PCB 118 PCB 160 PCB 119 PCB 161 PCB 120 PCB 162 PCB 121 PCB 163 PCB 122 PCB 164 PCB 123 PCB 165 PCB 124 PCB 166 PCB 125 PCB 167 PCB 126 PCB 168 PCB 127 PCB 169 PCB 128 PCB 170 PCB 129 PCB 171 PCB 130 PCB 172 PCB 131 PCB 173 PCB 132 PCB 174 PCB 133 PCB 175 PCB 134 PCB 176 PCB 135-4-
PCB 177 PCB 178 PCB 179 PCB 180 PCB 181 PCB 182 PCB 183 PCB 184 PCB 185 PCB 186 PCB 187 PCB 188 PCB 189 PCB 190 PCB 191 PCB 192 PCB 193 PCB 194 PCB 195 PCB 196 PCB 197 PCB 198 PCB 199 PCB 200 PCB 201 PCB 202 PCB 203 PCB 204 PCB 205 PCB 206 PCB 207 PCB 208 PCB 209 PCB Congeners, Total Polynuclear Aromatic Hydrocarbons 2-Acetylaminofluorene Acenaphthene Anthracene Acenaphthylene Benzo(a)anthracene Benzo(a)pyrene Polynuclear Aromatic Hydrocarbons Benzo(b)fluoranthene Benzo(ghi)perylene Benzo(k)fluoranthene Chrysene Dibenzo(a,j)acridine Dibenzo(a,h)acridine Dibenzo(a,h)anthracene Dibenzo(a,e)pyrene 7,12-Dimethylbenzyl (a) anthracene Fluoranthene Fluorene Indeno(1,2,3-cd)pyrene 3-Methylcholanthrene Naphthalene Phenanthrene Pyrene Low Level Polynuclear Aromatic Hydrocarbon Acenaphthylene Low Level Acenaphthene Low Level Anthracene Low Level Benzo(a)anthracene Low Level Benzo(b)fluoranthene Low Level Benzo(k)fluoranthene Low Level Benzo(g,h,i)perylene Low Level Benzo(a)pyrene Low Level Chrysene Low Level Dibenzo(a,h)anthracene Low Level Fluoranthene Low Level Fluorene Low Level Indeno(1,2,3-cd)pyrene Low Level Naphthalene Low Level Phenanthrene Low Level Pyrene Low Level Priority Pollutant Phenols 4-Chloro-3-methylphenol 2-Chlorophenol 2,4-Dichlorophenol 2,6-Dichlorophenol 2,4-Dimethylphenol 2,4-Dinitrophenol 2-Methylphenol 3-Methylphenol -5-
Priority Pollutant Phenols 4-Methylphenol Volatile Halocarbons Carbon tetrachloride Chloroethane 2-Methyl-4,6-dinitrophenol 2-Chloro-1,3-butadiene (Chloroprene) 2-Nitrophenol 2-Chloroethylvinyl ether 4-Nitrophenol Chloroform Pentachlorophenol Chloromethane Phenol cis-1,4-dichloro-2-butene 2,3,4,6 Tetrachlorophenol trans-1,4-dichloro-2-butene 2,4,6-Trichlorophenol 1,2-Dibromo-3-chloropropane 2,4,5-Trichlorophenol 1,2-Dibromoethane Thiophenol 1,3-Dichloro-2-propanol Volatile Aromatics 1,2,4-Trichlorobenzene, Volatile Benzene n-butylbenzene sec-butylbenzene tert-butylbenzene Bromobenzene Chlorobenzene 2-Chlorotoluene 4-Chlorotoluene 1,2-Dichlorobenzene 1,3-Dichlorobenzene 1,4-Dichlorobenzene Ethyl benzene Isopropylbenzene p-isopropyltoluene (P-Cymene) Naphthalene, Volatile n-propylbenzene Toluene Total Xylenes m/p-xylenes o-xylene 1,2,4-Trimethylbenzene 1,3,5-Trimethylbenzene Styrene Volatile Halocarbons Bromoacetone Bromochloromethane Bromodichloromethane Bromoform Bromomethane 3-Chloropropene (Allyl chloride) cis-1,3-dichloropropene trans-1,3-dichloropropene Dibromochloromethane Dibromomethane Dichlorodifluoromethane 1,1-Dichloroethane 1,2-Dichloroethane 1,1-Dichloroethene cis-1,2-dichloroethene trans-1,2-dichloroethene 1,1-Dichloropropene 1,2-Dichloropropane 1,3-Dichloropropane 2,2-Dichloropropane Hexachlorobutadiene, Volatile Methylene chloride Methyl iodide 1,1,1,2-Tetrachloroethane 1,1,2,2-Tetrachloroethane Tetrachloroethene 1,1,1-Trichloroethane 1,1,2-Trichloroethane Trichloroethene Trichlorofluoromethane 1,2,3-Trichloropropane 1,1,2-Trichloro-1,2,2-Trifluoroethane Vinyl chloride Chlorinated Hydrocarbon Pesticides Aldrin Atrazine -6-
Chlorinated Hydrocarbon Pesticides alpha-bhc beta-bhc delta-bhc Lindane alpha-chlordane gamma-chlordane Chlordane Total Chlorobenzilate 2,4'-DDD (Mitotane) 4,4'-DDD 4,4'-DDE 4,4'-DDT Diallate Dieldrin Endosulfan I Endosulfan II Endosulfan sulfate Endrin Endrin aldehyde Endrin Ketone Heptachlor Heptachlor epoxide Isodrin Mirex Methoxychlor Toxaphene Kepone Pentachloronitrobenzene Trifluralin Simazine Chlorophenoxy Acid Pesticides 2,4-DB 2,4-D 2,4,5-T 2,4,5-TP (Silvex) Dicamba Dichloroprop Dinoseb Dalapon MCPA MCPP Chlorophenoxy Acid Pesticides Pentachlorophenol Organophosphate Pesticides Azinphos ethyl Azinphos methyl Bolstar Carbophenothion Coumaphos Chlorpyriphos Chlorpyriphos methyl Chlorphenvinphos Crotoxyphos Cyanizine Demeton-O Demeton-S Diazinon Dichlorfenthion Dichlorvos Dicrotophos Dimethoate Dioxathion Disulfoton Ethion Ethoprop EPN Famphur Fenitrothion Fensulfothion Fenthion Fonophos Isophenphos Malathion Mevinphos Monocrotophos NALED Parathion ethyl Parathion methyl Pendimethalin Phorate Phosphamidon Prometon Prometryn -7-
Organophosphate Pesticides Ronnel Sulfotepp TEPP Terbufos Thionazin Tokuthion Trichlorfon Trichloronate Volatile Chlorinated Organics Miscellaneous Benzyl chloride Epichlorohydrin Asbestos in Friable Material Asbestos in Non-Friable Material-TEM Asbestos in Non-Friable Material-PLM Asbestos-Vermiculite-Containing Materials Boron, Total Cyanide, Total Cyanide, Free Formaldehyde Lead in Paint Lead in Dust Wipes Organic Carbon, Total Perchlorate Phenols Specific Conductance Sulfide (as S) Critical Agents Extractable Organic Halides Total Organic Halides B. Anthracis, Swabs and Swipes B. Anthracis, Powders, Fluids, Bulk Mat Botulinum Neurotoxin Brucella Burkholderia mallei Burkholderia pseudomallei F. tularensis Orthopox Ricin Toxin Y. pestis Benzidines Benzidine 3,3'-Dichlorobenzidine 3,3'-Dimethylbenzidine Volatile Organics Acetone Acetonitrile Carbon Disulfide Cyclohexane Di-ethyl ether 1,4-Dioxane Ethyl Acetate Ethylene Glycol Isobutyl alcohol Isopropanol 2-Hexanone 2-Butanone (Methylethyl ketone) Methyl acetate Methyl cyclohexane Methyl tert-butyl ether 4-Methyl-2-Pentanone n-butanol 2-Nitropropane Propionitrile o-toluidine tert-butyl alcohol Vinyl acetate Semi-Volatile Organics Acetophenone 4-Amino biphenyl Aramite Benzoic Acid Benzyl alcohol Benzaldehyde 1,1'-Biphenyl Caprolactam 1,2-Dichlorobenzene, Semi-volatile 1,3-Dichlorobenzene, Semi-volatile 1,4-Dichlorobenzene, Semi-volatile Dibenzofuran Diethyl sulfate Dihydrosafrole -8-
Semi-Volatile Organics Ethyl methanesulfonate Nitrosoamines N-Nitrosodimethylamine N-Nitrosodiethylamine Isosafrole N-nitrosomethylethylamine 2-Methylnaphthalene N-Nitrosodi-n-butylamine Methyl methanesulfonate N-Nitrosodi-n-propylamine Phenacetin N-nitrosomorpholine 2-Picoline N-nitrosopiperidine Piperonyl sulfoxide N-Nitrosopyrrolidine Resorcinol Safrole Minerals Bromide Toluene Diisocyanate Chloride O,O,O-Triethyl phosphorothioate Fluoride, Total Amines Sulfate (as SO4) Aniline o-anisidine Nutrients Nitrate (as N) Carbazole Nitrite (as N) 2-Chloroaniline Orthophosphate (as P) 4-Chloroaniline 4-Chloro-1,2-phenylenediamine 4-Chloro-1,3-phenylenediamine 5-Chloro-2-methylaniline a,a-dimethylphenethylamine Diphenylamine 1-Naphthylamine 2-Naphthylamine 2-Nitroaniline 3-Nitroaniline 4-Nitroaniline 5-Nitro-o-toluidine Methapyrilene 4,4'-Methylenebis(2-chloroaniline) 4,4'-Oxydianiline 1,4-Phenylenediamine 1,2-Diphenylhydrazine Pronamide Carbamate Pesticides Aldicarb Sulfoxide Aldicarb Petroleum Hydrocarbons Diesel Range Organics Gasoline Range Organics Oil and Grease Total Recoverable (HEM) Dioxins and Furans 2,3,7,8-Tetrachlorodibenzofuran 2,3,4,7,8-Pentachlorodibenzofuran 1,2,3,7,8-Pentachlorodibenzofuran 1,2,3,4,7,8-Hexachlorodibenzofuran 1,2,3,6,7,8-Hexachlorodibenzofuran 1,2,3,7,8,9-Hexachlorodibenzofuran 2,3,4,6,7,8-Hexachlorodibenzofuran 1,2,3,4,6,7,8-Heptachlorodibenzofuran 1,2,3,4,7,8,9-Heptachlorodibenzofuran 1,2,3,4,6,7,8,9-Octachlorodibenzofuran 2,3,7,8-Tetrachlorodibenzo-p-dioxin 1,2,3,7,8-Pentachlorodibenzo-p-dioxin 1,2,3,4,7,8-Hexachlorodibenzo-p-dioxin 1,2,3,7,8,9-Hexachlorodibenzo-p-dioxin 1,2,3,6,7,8-Hexachlorodibenzo-p-dioxin 1,2,3,4,6,7,8-Heptachlorodibenzo-p-dio Aldicarb Sulfone Carbofuran Nitrosoamines N-Nitrosodiphenylamine -9-
Dioxins and Furans 1,2,3,4,6,7,8,9-Octachlorodibenzo-p-di Are any of the additions or erasures requested on this form associated with State and/or Federal contracts? yes no I certify that the environmental laboratory analyses in the Solid and Hazardous Waste category for which approval has been requested are done using methods approved by the Commissioner of Health and that the information in this application is true to the best of my knowledge. NAME OF LABORATORY DIRECTOR SIGNATURE OF LABORATORY DIRECTOR MO / DAY / YEAR -10-