Chain of custody form, Westchester County Lab, Sep 2001

NYC 9/11 Public Portal Document

IU ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 Ulestchester County NYS-ELAP No. 10108 gene/DateSet:______________________ (914)593-5575 3lq0* Form A-70 (rev. 1/96) Wemple Type (circle one): 4650, 7309, 764Y PFB _ (Potable 3. Non-Potable Treated Bottle #‘s: $685, 8585 2. Non-Potable 4. Other____________ ._____ _ Chain of Custody?yes no Time/Date Collected: I | 2.7/20 s _AM_ Comments: Collected _Agency Code: _ .Source ID:. .Type Descriptor:. Collected From: Bill to: Location’s/Individual’s Name REsEevok Name/Company. Street__________________________________________ Street_______ City/St/Zip________ ____________________________ — City/St/Zip____ identification of Source.___________________________ — Phone#: Fax #: Collection Point BxB CA, CH, Bl?, Check#: Amounts

BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES C ORGANIC NONPOTABLE/SOLID ANALYSES ________________ Lab 42.,2 |X #:____ /49t (circle tests) ' C (circle tests) 1. Heterotrophic Plate 1. Trihalomethanes (52.) 1. 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 well, raw, stp) 4. Total Trihalomethane Potential (510) 4. Phthalates (606/8060) 4. Fecal Coliform (all samples) 5. Microextractables (504) 5. Organochlorine Pesticides (608/8080) 5. Microscopic 6. Pesticides (507) 6. PCB’s (Arochlors) (608/8080) 6. Macroscopic 7. Pesticides/PCB screen (508) 7. Herbicides (SM-18/6640; 8151) 7. API 8. PCB as Decachlorobiphenyl (508A) 8. Other Pesticides (SM-18/6630) _ 9. Herbicides (515) 9. Petroleum Hydrocarbon Scan (310-13) 10. Pesticides (525) 10. Glycols in Water Refrigerated? yes. .no 11. Carbamate Pesticides (531) 11. Acid Extractables (625/8270) 12. Glyphosate (547) 12. Base Neutral Extractables (625/8270) Chionnated?: yes. .no 13. Diquat (549) 13. GC/MS Unknown Scan 14. Chlorination Disinfection Byproducts (551) 14. Purgeable Halocarbons (DEF) Free Chionne Res:. mg/L 15. Haloacetic Acids (552) 15. Purgeable Aromatics (DEF) 16. Other Pesticides (SM-18/6630) 16. Pesticides (DEF) — Total Chlorine Res: .mg/L 17. Petroleum/Hydrocarbon Scan (310-13) 17. PCB’s (Arochlors) (DEF) s pH INORGANIC ANALYSES REQUESTED - Lab# (circle tests) S 1. Color 2. T urbidity 3. pH 20. Acidity 21. Alkalinity, as CaCOa 22. Bromide 39. Aluminum 40. Antimony 41. Arsenic 59. Potassium 60. Selenium 61. Silver g 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-volatiles 12. Total Organic Halides 31. Nitrogen, Total Kjeldahl as N 50. Cobalt 69. Pesticides/PCB's 13. Solids, Percent (%) 32. Oil and Grease 51. Copper 70. Disk Deliverables • Solids, Settleable 33. Phenol 52. Iron TCLP 2 Solids. Suspended 34. Phosphorus. Total as P 53. Lead 71. TCLP-Metals 16. 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 74. TCLP-Volatiles 19. Other____________ 38. UV254 57. Molybdenum 75. TCLP-BNA’s 58. Nickel

NYC-WTC_000026433