Chain of custody record, Westchester County Lab, Sep 2001

NYC 9/11 Public Portal Document

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM Vooldliste r VESTCHESTFR COUNTY LABORATONIES AND RESEARCH M g0\0) MRRN M1021a2DanaRoad,Vaihalla,Ne _91) 593-5575 wYork10595M_ _NSELAPNo.101 fmne : 1 1 ** lnabMLeanCForm.A-70.(rev.1/96, — aac-aloK=&2R180M/12030,03*264514 $* plc Type (circle one): ( Potable) Nog i . 0 li- .* "! 2. Non Potable 4. Other e Chain of Custody? yes no Time/Date Collected: _ ---- 4 41 qnemmggots: Collected By: _nec Agency Code: PWS *__ _ __Source ID: .Type Descriptor: Culecto From: JekeM Bill to: ? Location’s/individual’s Name 44 — Name/Company_ Street___4 C Street___________ City/St/Zip _ (g City/St/Zip Identification of Source________ Phone#:______ _ Fax#:__ Collection Point _ (_ | _P CA.CH, Bl? _ Check#: Amounts____

FAC FLRN ri GGICAl ANALYSIS QKGANC [alt. AMAl Y— I RGAANONPOTAEL t/St ID ANAI YS5 Lab#:_________ __ -____________ (circle tests) 1. Heterotrophic Plate Lab#:___ (circle tests) 1. Trihalomethanes (524) 20 1. Purgeable Halocarbons (624/8260) Count (hemodialysis & all others) 72.olatile Halocarbons (524) 2. Purgeable Aromatics (624/8260) 2. Coliform PZA (public supplies) • 3. Volatile Aromatics (524) 3. Acrolein & Acrylonitrile (624) 3. Coliform MPN. (privwell, raw, stp) ( 94r"Total Trihalomethane Potential (510) 4. Phthalates (625/8270) 4. Fecal Coliform (all samples) ‘5. Microextractables (504) 5. Organochlorine Pesticides (608/8081) o 5. Microscopic 6. Pesticides (507) 6. PCB's (Arochlors) (608/8081) 6. Macroscopic (7Pesticides/PCB screen (508) 7. Methoprene (616) -8. PCB as Decachlorobiphenyl (508A) 8. Herbicides (EPA1978/8151) er: 9.*Herbicides (515) 9. Pesticides (SMI8/6630) > / TOPesticides (525) 10. Petroleum Hydrocarbon Scan (310-13) ' Refrigerated? _ ___yes

Chlorinated:? yes no no **11 Carbamate Pesticides (531) 12. Glyphosate (547) 11. Glycols pe eem 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: __ ____________ _ ___________

INORCANIC ANALYSIS REQUESTED ■ ■ . (circle tests) 1. Color 2. Turbidity 20. Acidity 21. Alkalinity, as CaCOs 38lAluminum 40. Antimony 5 yihl :59.|Potassium 160. Selenium 3. pH 22. Bromide 41. Arsenic 61. Silver 2 4. Conductivity 5. Corrosivity (temp:______ °C) 23. Bromate/Chlorate/Chlorite 24. Chloride 42. Barium aaa ; 43 Beryllium 62. Sodium 63. Thallium ./14 25. Cyanide 44. Boron 64. Vanadium V l t ■ 6. BOD (5 day) 7. Soluble BOD (5 day) 26. Fluoride 45.Cadmium 65/ Zinc i 8. Carbonaceous BOD (5 day) 27. Hardness. Total as CaCOs 28. Nitrogen, Ammonia as N 46. Calcium, as CaCOa 47\Calcium, Ca42 CLP_ 9. Chemical Oxygen Demand 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 31. Nitrogen, Total Kjeldahl as N 50 Cobalt 12. Total Organic Halides 13. Solids, Percent (%) 14.Solids, Settleable 11 an Grease alld 3332,, 0Phenol 51 Copper 521 Iron 69. Pesticides/PCB’s . { i • Ptaroaoo .

53|Lead TCLP Colids, Suspended 3 L Ph r l.ii:: ■ I ■ lx 1 r. ■ I n I! i ' Motal; " : . : 1! 35. Phosphorus, Ortho as P 54 Magnesium 53 Caakoa 55 Manganese 2/ 0PPeuk

15756.MolMercury ybdenum.v 17. Solids, Total Dissolved 18. Other 19. Solids, ngn Total Volatile 7 Surfariaas A UY*1 /3 ICLP 1 lebicos / I CLP Volanles .'5. CANA 1 58. Nickel

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