Chain of custody record, Westchester County Lab, Sep 2001

NYC 9/11 Public Portal Document

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM 00 Westcllr seegovcom WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 (914) 593-5 75 ... NYS-ELAP No. 10108 Date Set: Form A-70 (rev.1/96) ■ Sample Type (circle one): ,** ..... 1 1. Potable y 3. Non Potable Treated Bottle si _ ___ —

2. Non Potable 4. Other Chain of Custody? , yes....... no Time/Date Collected: 144 < _ lit ’ Comments:___ /////* * * V = Collected By: Rc/b M S — Agency Code:..... PWS #: __ _____ Source ID: - Type Descriptor:

Collected Fom c‘O Bill to: Location’s/Individual’s Name _ . DP Name/Company Street (9 P‘ < ( lay 2 _________ Street _____ City/St/Zip i VAIWAllAA o<05 - Identification of Source — Phone#: ..... Fax#: _ ___ _ Collection Point dkotr . 0 64 1 /. . ...... .... ..... CA.CH, Bl? .... Check#: Amounts ======--==~-==-=====-----=-===========m======U-A=-ML-A=== =muee"=-=====*9pr==== A — BACTERIOLOGICAL ANALYSIS = ORGANIC POAHti AMAi Y. DPC*0NONPOTAPLFSO! in ANALYSIS Lab#; ......... ______ . ______ Lab# (circle tests) (circle tests) 1. Heterotrophic Plate Li nnalomethanes (524) 1. Purgeable Halocarbons (624/8260) Count (hemodialysis & all others) ’ 2. Volatile Halocarbons (524) 2. Purgeable Aromatics (624/8260) < 2. Coliform P/A (public supplies) , Aromatics (524) 3. Acrolete & Acrylonitrile (624) 3. Coliform MPN (priv well, raw. stp) 4. Total Trihalomethane Potential (510) 4. Phthalates (625/8270) 4. Fecal Coliform (ail samples) 5. Microextractables (504) 5. Organochlorine Pesticides (608/8081) " Microscopic 6. Pesticides (507) 6* PCB s (Arochlors) (608/8081) ^acroscopic ( ZZ.Pesticides/PCB screen (508) 7. Methoprene (616) 78 8. PCB as Decachlorobiphenyl (508A) 9. Herbicides (515) 8 Herbicides (EPA1978/8151) 9. Pesticides (SM18/6630) C10 Pesticides (525) 10. Petroleum Hydrocarbon Scan (310-13) Refrigerated? _ . . yes _ no 11, Carbamate Pesticides (531) 11. Glycols popaa Chlorinated:? yes ... no 12. Glyphosate (547) 12. Acid Extractables (625/8270) 13. Diquat (549) 13. Base Neutral Extractables (625/8270) Free Chlorine Res: mg/L 14. Chlorination Disinfection Byproducts (551) 14. GC/MS Semivolatile Unknown Scan 15. Haloacelic Acids (552) 15. Purgeable Halocarbons (DEF) Total Chlorine Res:.

pH mg/L • 16, Pesticides (SM18/6630) / 17.Pesticides/PCB‘s(DEF) i / j*he :■ ar i i t :. . : .. : : - Aontc ( ii-:

18. Other:__ 18, Other:______ _______ ___ ____ __ _.......

INORGANIC ANALYSIS REQUESTED - Lab#: ) (circle tests) 1. Color _ 20. Acidity 21. Alkalinity, as CaCO3 69, Aluminum 40 Antimony -/59 Potassium / 60, Selenium 2. Turbidity

IA 22. Bromide 41 Arsenic /_61. Silver 3. pH 23. Bromate/Chlorate/Chlorite 42} Barium 1 62. Sodium 4. Conductivity 43 Beryllium 5. Corrosivity (temp: . °C) 24. Chloride i 63.(Thallium 6. BOD (5 day) 25. Cyanide 44. Boron } 64. Vanadium 7. Soluble BOD (5 day) 26. Fluoride (45)Cadmiumni \65; Zinc 8. Carbonaceous BOD (5 day) 9. Chemical Oxygen Demand 27. Hardness, Total as CaCO 28. Nitrogen, Ammonia as N 46. Calcium, as CaCO 47, Calcium, Ca 12 [CLPmae 66. Metals/CN 10. Dissolved Oxygen 29. Nitrogen. Nitrate as N (48! Chromium, Total 67. Volatiles 11. Total Organic Carbon 30. Nitrogen. Nitrite as N 49. Chromium, Hexavalent 68. Semi-violatiles 31. Nitrogen, Total Kjeldahl as N (50, Cobalt 12. Total Organic Halides 69. Pesticides/PCB’s 32. Oil an Grease 51 (Copper 1 3. Solids, Percent (%) olids. Settleable 3 , Phenol 52; Iron 5 3 (Lead 70. Disk Deliverables TCLP e ■ olids. Suspended 34. Phosphorus Total as P | 54 (Magnesium 71,TCLP-Metals ' 16. Solids, Total 35. Phosphorus, Ortho as P 72.TCLP-Pesticides 36. Sulfates 1 55 Manganese 17. Solids, Total Dissolved 37, Surfactants _ 156.Mercurv /s it ’I ।: I ■■■:;■:! !< I- ■

38.UV254e 57 Molybdenum nd 18. Solids, Total Volatile 19, Other . 1 m 58/Nickeln 74. 1 Ph : *— / ul l ! NA-

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