Chain of custody form, Westchester County Lab, Sep 2001

NYC 9/11 Public Portal Document

t ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM ster’ WESTCHESTER COUNTY LABORATORIES AND RESEARCH iv.com 2 Dana Road, Valhalla, New York 10595 (914) 593-5575 NYS-ELAP No. 10108 drateset 7 Form A-70 (rev.1/96)

Sample Type (circle one): 8534,8533,399,535,6586,397 1. Potable 3. Non Potable Treated Bottle #’s: 432/ 500b, 5^ f lo 19 S 00 Si 2. Non Potable 4. Other Chain of Custody? yes no Time/Date Collected: 019 / /ana / 0842 Comments:____ Collected By: J, bolfon Agency Code: _ Source ID: .Type Descriptor. Collected From: Bill to: Location’s/ndividual’s Name Name/Company Street ________________________ Street________ ________________ ___________ ' _ 79. Identification of Source _ _____________ Phone#:______ Fax#: — -519SD. Amounstre s.”. Collection Poi_ CA,CH, Bl? Check# =========================== munotctera ‘ ■■ —,*** *

BACTERIOLOGICAL ANALYSIS ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOUD ANALYSIS Lab#:__________ _ _________ Lab#: "aor ■ (circle tests) 1. Heterotrophic Plate (circle tests) 1. Trihalomethanes (524) 1. Purgeable Halocarbons (624/8260) 2' Count (hemodialysis & all others) /2. Volatile Halocarbons (524) 2. Purgeable Aromatics (624/8260) 2. Coliform P/A (public supplies) 3. Coliform MPN (priv well, raw, stp) (LC Volatile Aromatics (524) Total Trihalomethane Potential (510) 3. Acrolein & Acrylonitrile (624) 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 7. Pesticides/PCB screen (508) 7. Methoprene (616) Ar__________ 8. PCB as Decachlorobiphenyl (508A) .9. Herbicides (515) 8. Herbicides (EPA1978/8151) 9. Pesticides (SM18/6630) Refrigerated? yes no 10. Pesticides (525) 10. Petroleum Hydrocarbon Scan (310-13) 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:. • • ■■ _ 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) T. 18. Other_______________________ 18. Other___________________ * . 7 INORGANIC ANALYSIS REQUESTED - Lab#: (circle tests) 1. Color 20. Acidity 39. Aluminum 59. Potassium 2. Turbidity 21. Alkalinity, as CaCO3 40. Antimony 60. Selenium 3. pH 22. Bromide 41. Arsenic 61. Silver 4. Conductivity 23. Bromate/Chlorate/Chlorite 42. Barium 62. Sodium P. 5. Corrosivity (temp: °C) 24. Chloride 43. Beryllium 63. Thallium N 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 C2 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 SO.Cobalt 69. Pesticides/PCB’s X 13. Solids, Percent (%) 32. Oil an Grease 51 .Copper 70. Disk Deliverables 14. Solids, Settleable 33. Phenol 52. Iron 53. Lead TCLP Colids, Suspended 34. Phosphorus Total as P 71 TCLP-Metals la Solids, Total 35. Phosphorus, Ortho as P 454 Magnesium 72.TCLP-Pesticides 17. Solids, Total Dissolved 36. Sulfates 55 Manganese 73. TCLP-Herbicides 18. Solids, Total Volatile 37. Surfactants 56. Mercury 57 Molyodenum 74. TCLP-Volatiles 19. Other:________________ 38. UV254 58. Nickel 75.TCLP-BNAs

NYC-WTC_000026446