Chain of custody record, handwritten notes, sample receipt documentation

NYC 9/11 Public Portal Document

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM ster WESTCHESTER COUNTY LABORATORIES AND RESEARCH com 2 Dana Road, Valhalla, New York 10595 1E (914) 593-5575 NYS-ELAP No. 10108 ATime/Date Set: Form A-70 (rev.1/96)

Sample Type (circle one): otable 3. Non Potable Treated Bottle #s: . CoCHMBGY 2. Non Potable 4. Other _______________________ Chain of Custody? yes no Time/Date Collected: 9/3/0/ Comments: Collected By:Agency Code:. NCWE _ Source ID: Type Descriptor Collected From: Bill to: Location’s/Individual’s Name ______ ________________________ Name/Company Street----- Alole. 02 — Street_________ City/St/Zip_____________________________________________ City/St/Zip Identification of Source___________________________________ Phone#:_______ Fax#: Collection Point________________________________________ C. 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 (priv well, raw, stp) 4. Total Trihalomethane Potential (510) 4. Phthalates (625/8270) 6 4. Fecal Coliform (all samples) 5. Microextractables (504) 5. Organochlorine Pesticides (608/8081) 5. Microscopic 6. Pesticides (507) 6. PCB’s (Arochlors) (608/8081) 6. Macroscopic 7. Pesticides/PCB screen (508) 7. Methoprene (616) (API pother_______________ 8. PCB as Decachlorobiphenyl (508A) 8. Herbicides (EPA1978/8151) 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 C Chlorinated:? yes no 12. Glyphosate (547) 12. Acid Extractables (625/82 70) 5 13. Diquat (549) 13. Base Neutral Extractables (625/8270)'- Free Chlorine Res:. mg/L 14. Chlorination Disinfection Byproducts (551) 14. GC/MS Semivolatile Unkne wn Scan " Total Chlorine Res: mg/L 15. Haloacetic Acids (552) 15. Purgeable Halocarbons (I )EF) 16. Pesticides (SM18/6630) 16. Purgeable Aromatics (DE ) pH 17. Petroleum/Hydrocarbon Scan (310-13) 17. Pesticides/PCB’s (DEF) 5 18. Other:__________________________ 18. Other:_________________ 5 INORGANIC ANALYSIS REQUESTED - Lab#: (circle tests) 1. Color 20. Acidity 39. Aluminum — 59. Potassium - 2. Turbidity 21. Alkalinity, as CaCOs 40. Antimony— 60. Selenium— 3. pH 22. Bromide 41. Arsenic • 61. Silver • 4. Conductivity 23. Bromate/Chlorate/Chlorite 42. Barium - 62. Sodium —‘ 5. Corrosivity (temp: °C) 24. Chloride 43.Beryilium—— 63. Thallium ~ 6. BOD (5 day) 25. Cyanide 64. Vanadium 7. Soluble BOD (5 day) 26. Fluoride r nj A5. Cadmium • 65. Zinc • 8. Carbonaceous BOD (5 day) 27. Hardness, Total as PaCOU 46. Calcium, as CaCOs CLP 9. Chemical Oxygen Demand 28. Nitrogen, Ammonialas N 47. Calcium, Ca* 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 50.Cobalt • 69. Pesticides/PCB’s 13. Solids, Percent (%) 32. Oil an Grease 51. Copper— 70. Disk Deliverables ad Solids, Settleable 33. Phenol 52. Iron • . Solids, Suspended 53.Lead - TCLP 34. Phosphorus Total as P 16. Solids, Total 54 Magnesium • 71 TCLP-Metals 35. Phosphorus, Ortho as P 55 Manganese y 72.TCLP-Pesticides 17. Solids, Total Dissolved 36. Sulfates 18. Solids, Total Volatile / ' 37. Surfactants 56. Mercury — 73. TCLP-Herbicides 19. Other: -• Sw 57 Molybdenum • 74. TCLP-Volatiles 38. UV254 75.TCLP-BNA’s 58. Nickel •

NYC-WTC_000025712