Chain of custody record, Westchester County Lab, Sep 2001

NYC 9/11 Public Portal Document

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM ster WESTCHESTER COUNTY LABORATORIES AND RESEARCH vcom 15 2 Dana Road, Valhalla, New York 10595 (914) 593-5575 NYS-ELAP No. 10108 Time/Date Set: Form A-70 (rev.1/96) ple Type (circle one): 1 Potable 3. Non Potable Treated M... DUlUv 77 We 2306 3 . 30462 2. Non Potable 4. Other Chain of Custody? yes no Time/Date Collected: ?-/5-0/ Comments: Collected By:. __ Agency Code: PWS#_______ Source ID: .Type Descriptor Collected From: ‘ Bill to: Location’s/ndividuar’s Name 4/-5PczAt___ Name/Company _ Street SHARES Street________ City/St/Zip___________________:_____________________ _ Identification of Source • ________________________ Phone#: . Fax#: Collection Point —SF Zauso_________ CA,CH,Bl?. Check: VAmotiis" is 09" - •

BACTERIOLOGICAL ANALYSIS Lab#:____________________ ORGANIC POTABLE ANALYSIS Lab#:___________________ MHtOnGANICNONPOTABLE/SOLANALYSS (circle tests) (circle tests) • 1. Heterotrophic Plate Trihalomethanes (524) / 1.Purgeable Halocarbons (624/8260) Count (hemodialysis & all others) Volatile Halocarbons (524) 2. Purgeable Aromatics (624/8260) 2. Coliform P/A (public supplies) _ 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) 7AP her_______________ 8. PCB as Decachlorobiphenyl (508A) 9. Herbicides (515) 8. Herbicides (EPA1978/8151) 9. Pesticides (SM18/6630) 2es Refrigerated? yes no C10 Pesticides (525) 10. Petroleum Hydrocarbon Scan (310-13); 11. Carbamate Pesticides (531) 11. Glycols ** Chlorinated:? yes no 12. Glyphosate (547) 12. Add Extractables (625/8270) 2 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) j. pH 17. Petroleum/Hydrocarbon Scan (310-13) 17. Pestlcldes/PCB’s (DEF) “4* 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 4. Conductivity 23. Bromate/Chlorate/Chlorite 42. Barium 62. Sodium 5. Corrosivity (temp: 9C) 24. Chloride 43. Beryllium 63. Thailiugr 6. BOD (5 day) 25. Cyanide 44. Boron 64. Vanadium < .. 3 7. Soluble BOD (5 day) 26. Fluoride 45. Cadmium 65. Zinc CO sand 8. Carbonaceous BOD (5 day) 27. Hardness, Total as CaCOs 46. Calcium, as CaCOs CLP -ee 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 ' aSolids, Suspended 34. Phosphorus Total as P 53.Lead • Solids, Total 35. Phosphorus, Ortho as P 54 Magnesium 71 .TCLP-Metals 36. Sulfates 55 Manganese 72.TCLP-Pesticides 17. Solids, Total Dissolved 73.TCLP-Herbicides 18. Solids, Total Volatile 37. Surfactants 56. Mercury 38. UV254 57 Molybdenum 74. TCLP-Volatiles . 19. Other________________ 75.TCLP-BNA’s 58. Nickel asdssdecldads NYC-WTC_000025886