Chain of custody record, Westchester County Lab, Sep 2001

NYC 9/11 Public Portal Document

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM ster 1 iv.com WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 15 (914) 593-5575 NYS-ELAP No. 10108 Time/Date Set: Form A-70 (rev.1/96) sMRpietype (circle one): (1 Potable 3. Non Potable Treated Bottle *s: 2067 /3/ 3 So 2. Non Potable 4. Other__________________ Chain of Custody? yes no Time/Date Collected: 2-/s- 0f 9855 Comments: Collected By: VA/AS Agency Code: PWS#:_______ Source ID: .Type Descriptor: Collected From: Bill to: Location’s/Individual’s Name A-S/6E/L Name/Company _ Street________________ 7AES Street City/St/Zip ________ ___________ :________ ____ _____________ Identification of Source___ . 3 _ t/ Phone#: _ Faxif: Collection Point

BACTERIOLOGICAL ANALYSIS $773 —/p9 —Scacnihe ORGANIC POTABLE ANAGYSS T Check# Amounts ” .p-==-=================y========p=van9=9==.=y==59 IC NONPOTABJ.E/SOLJD ANALYSIS Lab#:____________________ Lab#:_______ 4L C X ■■ w: (circle tests) (circle tests) i _ 1. Heterotrophic Plate Count (hemodialysis & all others) 1. Trihalomethanes (524) 2) Volatile Halocarbons (524) I ? 1. Purgeable Halocarbons (624/8260) 2. Purgeable Aromatics (624/8260) 2. Coliform P/A (public supplies) 3. Volatile 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) 5. Microscopic 6. Pesticides (507) 6. PCB’s (Arochlors) (608/8081) 6. Macroscopic ( Pesticides/PCB screen (508) 7. Methoprene (616) 57 r— Refrigerated? yes no 6 8. PCB as Decachlorobiphenyl (508A) Herbicides (515) Pesticides (525) 8. Herbicides (EPA1978/8151) 9. Pesticides (SM18/6630) to 10. Petroleum Hydrocarbon Scan (310-13) '' 11. Carbamate Pesticides (531) 11. Glycols 6 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) L pH 17. Petroleum/Hydrocarbon Scan (310-13) 17. Pesticides/PCB’s (DEF) 18. Other_______________________ 18. Other_____________________

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 e 4. Conductivity 23. Bromate/Chlorate/Chlorite 42. Barium 62. Sodium Q 9J 5. Corrosivity (temp: °C) 24. Chloride 43. Beryllium 63. Thailium ** ** 6. BOD (5 day) 25. Cyanide 44. Boron 64. Vanadium ... 7. Soluble BOD (5 day) 26. Fluoride 45. Cadmium 65. Zinc 1 8. Carbonaceous BOD (5 day) 27. Hardness, Total as CaCOs 46. Calcium, as CaCOs CLP i 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-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 14. Solids, Settleable 33. Phenol 52. Iron TCLP (Folids, Suspended 34. Phosphorus Total as P 53.Lead 71 .TCLP-Metals ’ 1. Solids, Total 35. Phosphorus, Ortho as P 54 Magnesium 55 Manganese 72. TCLP-Pesticides 17. Solids, Total Dissolved 36. Sulfates 56. Mercury 73. TCLP-Herbicides 18. Solids, Total Volatile 37. Surfactants 74. TCLP-Volatiles • 19. Other________________ 38. UV254 57 Molybdenum 75.TCLP-BNA’S 58. Nickel

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