Chain of custody record, Westchester County Lab, Sep 2001

NYC 9/11 Public Portal Document

655( e ■ k*hl! A;: 1:: ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FOHM WESTCHESTER COUNTY LABORATORIES AND RESEARCH I

2 Dana Road, Valhalla, New York 10595 (914) 593-5575

■, me/Date Set: ) y i * S7 [;NYS-ELAP —3(GCC) Eeet - 7. No. 10108 . Form A-70(rev1/96)_ -•---------------------- /t meepree. =55% 16 5 e , Sample Type (circle one): sa-5(5 "— 6 T5— > eL < P- 355, 3 * . 1. Potable- 3. Non Potable Treated Bottle rs:Cawss ! 10. 153 AC_ _____ _______ : 2. Non Potable 4. Other_______ Chain of Custody?___ yes____ no Time/Date Collected: 152 5/ 7- /5- o / .. Comments:_______ ___ Col ected Bv- AW/AA Agency Codo.: _ PWS #: Source D—Tvpe DesnP"o— Col actedsomem4A/02a77C Location’s/Individual’s Name... A Bill to: 010110//00///1/ _______ Name/Company _ Street "7 Weer LAME 12 — Street! City/St/Zip UAl LU lLA Y City/StZip_ Identification of Source____ Phone#: ______ Fax#: Collection Point _.....C Ami _B EEA( 5 (/9 CA,CH, BI? ____ ____ __ 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) (2olatile Halocarbons (524) 2. Purgeable Aromatics (624/8260) 2. Coliform P/A (public supplies) (3./olatile Aromatics (524) 3. Acrolein & Acrylonitrile (624) 3. Coliform MPN (privwell, 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 CZ.Pesticides/PCB screen (.508) 7. Methoprene (616) 78 8. PCB as Decachlorobiphenyl (508A) 8. Herbicides (EPA1978/8151) 8 er: 9.-Herbicides (515) A0./Pesticides (525) 9. Pesticides (SM18/6630) 10. Petroleum Hydrocarbon Scan (310-13) Refrigerated? yes___ no n Carbamate Pesticides (531) 11. Glycols 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 Total Chlorine Res:_ _ _____ mg/L 15. Haloacetic Acids (552) 15. Purgeable Halocarbons (DEF) 16. Pesticides (SM18/6630) 16. Purgeable Aromatics (DEF) pH 17. Petroleum/Hydrocarbon Scan (310-13) 17. Pesticides/PCB’s (DEF) 18. Other:.._________ ______ _ —... ....... 18. Other:

INORGANIC ANALYSIS REQUESTED - Lab#: (circle tests) /0/ 39. Aluminum yo— . . 1. Color 20. Acidity | ‘ X—59. Potassium 21. Alkalinity, as CaC03 : 40. Antimony ; 60. Selenium 2. Turbidity 3.pH_oe 22. Bromide 41. Arsenic 42.Barium . " I 61. Silver . 1 62. Sodium 4. Conductivity 5. Corrosivity (temp:...... .... °C) 23. Bromate/Chlorate/Chlorite 24. Chloride (43,Beryllium - I 1 1 i 63./Thallium 6. BOD (5 day) 25. Cyanide 44. Boron ‘ 64. Vanadium 7. Soluble BOD (5 day) "G. Fha idie 45.Cadmium | 65, Zinc 8. Carbonaceous BOD (5 day) 9. Chemical Oxygen Demand 27. Hardness, Total as CaCO3 28. Nitrogen, Ammonia as N 46. Calcium, as CaCOa 47.Calcium, Ca *2 CLP 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 12. Total Organic Halides 31. Nitrogen, Total Kjeldahl as N 50Cobalt 69. Pesticides/PCB’s 33 Solids. Percent (%) 32. Oil an Grease i 51 Copper 70. Disk Deliverables . Solids, Settleable 33. Phenol Iron 5532.Lead TCLP (psolids. Suspended 19.Solids, Total 34. Phosphorus Total as P 35. Phosphorus, Ortho as P 54 Magnesium 71 TCLP-Metals 36. SuSulrffactants ates _ | 56.MaMercury —09 155 nganese da / ' i l i ' • l ■< * 1. . lotl I.’::- • s. -u 37, Ai CPP*r* 18. Solids, Total Volatile : 19? Other: a 38.UV254 58. 57 MolNickelybdenummmte Ps : ICIPYAido A t.

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