Chain of custody record, Westchester County Lab, Sep 2001

NYC 9/11 Public Portal Document

sTer ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH vcom 2 Dana Road, Valhalla, New York 10595 UE (914) 593-5575 NYS-ELAP No. 10108 Time/Date Set: Form A-70 (rev.1/96) WhpleType (circle one):

(1Potable 3. Non Potable Treated Bottle #s: 2%o1o 35532 2. Non Potable 4. Other Chain of Custody? no Time/Date Collected: _ 7/5-0/' 0936 Comments: Collected By: VM / i _ Source ID: Type Descriptor: Agency Code: Collected From: Bill to: Location’s/Indhridual’s Nam2*=5A“Sres Name/Company Street_______ City/St/Zip___________________;___________________ City/St/Zlp___ Identification at Source " _ _________________ Phone#: Fax#: Collection Point 72560 . _____ ' .2701779 : ~ ~ CA,CH,Bl? Check: Amount$ BACTERIOLOGICAL ANALYSIS ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLID ANALYSIS Lab#:___________ " * Lab#: _____ io — (circle tests) (circle tests) _ 1. Heterotrophic Plate (D Trihalomethanes (524)/ 1/0 1. Purgeable Halocarbons (624/8260) Count (hemodialysis & all others) C2. Volatile Halocarbons (524) 2. Purgeable Aromatics (624/8260) 2. Coliform P/A (public supplies) €3.olatile Aromatics (524)------:—■— 3. Acrolein & Acrylonitrile (624) 3. Coliform MPN (priv well, 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 <z. Pesticides/PCB screen (508) 7. Methoprene (616) 7API 8. PCB as Decachlorobiphenyl (508A) 8. Herbicides (EPA1978/8151) Cher:___________ 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 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. Potassium “ 2. Turbidity 21. Alkalinity, as CaCOs 40. Antimony 60. Selenium; 0 . 3. pH 22. Bromide 41. Arsenic 61. Silver i co * 4. Conductivity 23. Bromate/Chlorate/Chlorite 42. Barium 62. Sodium ? mat •=* 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 TCLP g Solids, Suspended 34. Phosphorus Total as P 53.Lead 54 Magnesium 71 TCLP-Metals Solids, Total 35. Phosphorus, Ortho as P 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 r 57 Molybdenum 58. Nickel 75.TCLP-BNAS

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