Chain of custody record, Westchester County Lab, Sep 2001

NYC 9/11 Public Portal Document

EN VIRONMENTAL SERVICES SAMPLE SUBMISSION FORM t shestes MOVCOII WESTCHESTER COUNTY LABORATORS AND RESEARCH . ■8 Rr 1 2 Dana Road, Valhalla New York 105954* (914)593:5575 A- 0S catwgngeg PotefoeARPE . ***** aa a$ atk pi ct .NYS-ELAP No. 10108 .... Form A-70 (rev. 1/96)

Sample fvpv . =*x=="a 1. Potable ) 3. Non Potable Treated meppdz, 29. fc 22 809.4 y7 fejjBottie #s: -7..... ..... —_________ /.. -. _.... 2... ..... (ame*C(5EEEEECGEeGEGGe, J

2 Non Potable 4. Other.... ... ............... - ...______ 5 Chain of Custody?___ yes. . .... no Time/Date Collected:___/15_ I Comments:...... Collected By: AN . , _ Agency Code: .__ ___ _ | PWS #......... Source ID: _Type Descriptor:_____ Collected From: Bill to: Location’s/ndividual’s Name... Street _.. La AAM -mn. Name/Company

ke. De wC__ Street City/stZipalo I . ..... AM__ _ ;5 ; City/StZip .... “———————07/ Identification of Source _ ____ Phone" __ Collection Point -E CA,CH, Bl? 1. — Check#:. .Amounts. ------ - ----- I t BACTERIOLOGICAL ANALYSIS ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLID ANALYSIS Lab#:____ J_________________ __— Lab# RR (circle tests) (circle tests) 1. Heterotrophic Plate 1. Trihalomethanes (524) 1. Purgeable Halocarbons (624/8260) Count (hemodialysis & all others) (22 Volatile Halocarbons (524) 2. Purgeable Aromatics (624/8260) 2. Coliform P/A (public supplies) ( Volatile Aromatics (£524) ' :.; 3. Acrolein & Acrylonitrile (624) 3. Coliform MPN (pnv well, 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) 6. PCB's (Arochlors) (608/8081) ' Macroscopic (7, Pesticides/PCB screen (508) 7. Methoprene (616)' 7. 8. PCB as Decachlorobiphenvi (508A) 8. Herbicides (EPA1978/8151) 8. Offer:___ 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 0002. Chlorinated:? ........ yes ...... no 12. Glyphosate (547) 12. Acid Extractables (625/8270) Free Chlorine Res:.... . ...... . mg/LA 13. Diquat (549) 13. Base Neutral.Extractables (625/8270) 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 17. Petroleum/Hydrocarbon Scan (310-13) 17. Pesticides/PCB’s (DEF) 18. Other:____ 18. Other:. ___ ------ ;----------- t-------------------------- INORGANIC ANALYSIS REQUESTED - Lab#: _. / /.) (2 X I (circle tests) 1. Color ngapn 20. Acidity ' . t 44 /39. Aluminum 4+ 9.7 Potassium 2. Turbidity 21. Alkalinity, as CaCOs | 40. Antimony 60. Selenium 3. pH 22. Bromide ! 41.'Arsenic 61. Silver 4. Conductivity 23. Bromate/Chlorats/Chiorite < 42. Barium 62. Sodium 24. Chlofide 1 5. Corrosivity (temp:______PC) (43/Beryllium 63. Thallium 6. BOD (5 day) 25. Cyanide 44. Boron 64. Vanadium 26 H-trei • • 45. Cadmium 7. Soluble BOD (5 day) 46. Calcium, as CaCs GLPZinc 65/ 8. Carbonaceous BOD (5 day) 27. Hardness, Total as CaCO3 28. Nitrogen, Ammonia as N 4 /.Calcium, Ca 12 66. Metals/CN 9. Chemicalxygen Demand 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 12. Total. Organic Halides 31. Nitrogen, Total Kjeldahl as N /50 Cobalt 69. Pesticides/PCB’s -3. Solids, Percent (%) 32. Oil an Grease f 51 (Copper 70. Disk Deliverables golids. Settleable iolids. Suspended 33. Phenol 3-;. f I a thios a: 1.4 as i 1 524 Iron -53 Lead_ TCLP 16. Solids. Total 36. Sulfates ee. 5455 Magnesium — 100 Moltlt 3, Encsohon, ■. phio no !' .-.: I t i‘ h lkkai Manganese

19.18. other TotalnVolatilT Solids, — 17. Solids, Total Dissolved e . 37.38.UV254 Surfactants 5 56, Mercury a o! ! t-oa) 74. TCLP-Volatiles —| 5758.Molybdenum Nickel me 75. TCLP-BNA’s

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