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 jv.com 2 Dana Road, Valhalla, New York 10595 (914) 593-5575 NYS-ELAP No. 10108 Time/Date Set: Form A-70 (rev.1/96) sipietype (circle one): (1 Potable 3. Non Potable Treated Bottle _ _______ 2071 33720 2. Non Potable 4. Other_____________________ Chain of Custody? —yes no •-6-0/ Time/Date Collected: _ /0%s Comments: Collected By:. VAAS __ Agency Code: _ Source ID: .Type Descriptor: Collected From: Bill to: Location’s/Individual’s Name ______ _________________ Name/Company Street______________ SALeS Street________ City/St/Zip— City/SuZip Identification of Source 2 Phone#:______ Faxi Collection Point *.SA0 SP/52 CA,CH,BI? Check#: Amounts. C' BACTERIOLOGICAL Lab#: : ANALYSIS" / -X ' ■ ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLID ANALYSIS Lab#:____________ __ __ - - (circle tests) (circle tests) . Q 1. Heterotrophic Plate 1. Trihalomethanes ($24) /290 A. 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 wed, 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) 7AP1 8. PCB as Decachlorobiphenyl (508A) 8. Herbicides (EPA1978/8151) _________________________ 9. Herbicides (515) 9. Pesticides (S118/6630) (0) Pesticides (525) 10. Petroleum Hydrocarbon Scan (310-13) Refrigerated? yes no 11. 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) 1. Color 20. Acidity 39. Aluminum 59. potaSslum. 2. Turbidity 21. Alkalinity, as CaCOs 40. Antimony x 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. Beryllium 63. Thallium 6. BOD (5 day) 25. Cyanide 44. Boron 64. Vanadium 7. Soluble BOD (5 day) 26. Fluoride 45. Cadmium 65. Zinc 8. Carbonaceous BOD (5 day) 27. Hardness, Total as CaCOs 46. Calcium, as CaCOs CLP 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 34. Phosphorus Total as P 53.Lead TCLP (Solids, Suspended 71 TCLP-Metals W Solids, Total 35. Phosphorus, Ortho as P 54 Magnesium 72. TCLP-Pesticides 17. Solids, Total Dissolved 36. Sulfates 55 Manganese 73.TCLP-Herbicides 18. Solids, Total Volatile 37. Surfactants 56. Mercury 38. UV254 57 Molyodenum 74. TCLP-Volatiles - 19. Other:________________ 75.TCLP-BNA’s 58. Nickel

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