Chain of custody record, Westchester County Lab, Sep 2001

NYC 9/11 Public Portal Document

UA 7 ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM • yools X'l . . WESTCHESTER COUNTY LABORATORIES AND RESEARCH mpes© 2 Dana Road, Valhalla, New York 10595 914 5935575 NYS-ELAP No. 10108 /Date Set: Form A-70 (rev. 1/96) .

Sample Type (circle one): / / , e 0 /5> /1. Potable - 3. Non Potable Treated Bottle # s: . _ _A 2. Non Potable 4. Other__ Chain of Custody?___ yes _ ...... no Time/Date Collected: -/ Comments:________ _ Collected Bv007dg o7 Agency Code: ________ PWS #: _ ______— Source ID:'__ _____ Type Descriptor: Collected From: Bill to: Location's/Individual’s Name _____________ ___________ __ __ Name/Companv---- Street _/*(*GA ' Street ___________ City/St/Zip -(he/'e // /0575 City/StZip — Identification of Source Phone#: _Fax#:_ Collection Point 24 CA.CH, Bl? Check#: Amounts....

BACTERIOLOGICAL ANALYSIS ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLID ANALYSIS Lab#:_____________________ Lab#: -_ _______ __ ___ _ __ _______ (circle tests) (circle tests) 1. Heterotrophic Plate 1 Trihalomethanes (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) ' -3.Volatile Aromatics (524) 3. Acrolein & Acrylonitrile (624) 3. Coliform MPN (privweil, raw, stp) 4. Total Trihalomethane Potential (510) 4. Phthalates (625/8270) 4. Fecal Coliform (all samples) 5. Microextractables (504) 5. Organochlorine Pesticides (608/8081) Microscopic 6. Pesticides (507) (7Pesticides/PCB screen (508) 6. PCB’s (Arochlors) (608/8081) ■ Macroscopic 7. Methoprene (616) 8 PCB as Decachlorobiphenyl (508A) 8. Herbicides (EPAI 978/8151) 8. Gmer__________ _ 9. Herbicides (515) 9. Pesticides (SM18/6630) 10. Pesticides (525) 10. Petroleum Hydrocarbon Scan (310-13) Refrigerated?____ yes no 11. Carbamate Pesticides (531) 11. Glycols Metqnplgaoapn 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. Haloacetic Acids (552) 15. Purgeable Halocarbons (DEF) Total Chlorine Res:______ ... mg/L 16. Pesticides (SM18/6630) 16. Purgeable Aromatics (DEF) pH ... 117. Petroleum/Hydrocarbon Scan (310-13) 2 18.Other 17. Pesticides/PCB’s (DEF) B 18. Other _ / INORGANIC ANALYSIS REQUESTED - Lab#: / (circle tests) — 1. Color 20. Acidity f 39) Aluminum / 59, Potassium 21. Alkalinity, as CaCOs ; 40. Antimony i 60s Selenium 2. Turbidity 3, pH 22. Bromide 23. Bromate/Chlorate/Chlorite ; 41/Arsenic 5 42. Barium j 61.Silver 1 62.1 Sodium 4. Conductivity 5. Corrosivity (temp: °C) 24. Chloride s 4.1 Beryllium ' - 63. Thallium 6. BOD (5 day) 25. Cyanide 144.Boron : 45. Cadmium 64/ Vanadium 26. Fluoride \ 65: Zinc 7. Soluble BOD (5 day) 27. Hardness, Total as CaCOs 46. Calcium, as CaCOs CLP 8. Carbonaceous BOD (5 day) 9. Chemical Oxygen Demand 28. Nitrogen, Ammonia as N ‘47 Calcium, Ca 2 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-violafiles 12. Total Organic Halides 31. Nitrogen, Total Kjeldahl as N f 50. Cobalt i i,*etno tr t 32. Oil an Grease i 51 Copper 2 l )h ! '■ iv res 3 Solids, Percent (%) 33, Phenol 153.Lead f 52) iron TCLP wadllt! "■1 ! hophorp is i * i 54’. Magnesium 10m "‘Mot 16. Solids, Total 55 Manganese 35. Phosphorus, Ortho as P -

56. Mercury ! —----- Ti i nohooo* 17. Solids, Total Dissolved 18. Solids, Total Volatile 37. 36. Sulfates Surfactants ---- 38.UV254 57 Molybdenum—-- . CLl ia h o, I HIT 19. Other: **21__ 1.58. Nickel mtni 75. TCLP-BNA’s

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