Chain of custody form, Westchester County Lab, Sep 2001

NYC 9/11 Public Portal Document ***osa oirvrr P sorrrwur $77

> ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 25 15 (914)593-5575 . NYS-ELAP No. 10108 | Form A-70 (rev. 1/96) (Date Set:______ Sample Type (circle one): ^b5-Ot 7305, 764“ ■ 1. Potable 3. Non-Potable Treated Bottle #’s: 0056, 6652,8 G *2 5, S 585 2. Non-Potable 4. Other _________ __ ____ Chain of Custody? yes no Time/Date Collected:, -123/20 AM _ Comments:___ Collected BwHIACouB Agency Code:_____ - _ PWS ________ Source ID: Type Descriptor: Collected From: BUI to: Location's/individuars Name. Ancw/REsEPVo — Name/Company. Street______________ ■________________ ___ .-------------- _ Street City/St/Zio : : : a_____ _ City/St/Zip____ Identification of Source ** ______ :_____ ____ Phone#: _Fax# Collection Point. ;' ! - Bx5_ __ CA.CH, Bl?_ .. • . t . .. * . . * ■ ■ ■' Check#:,. Amounts. _________________________ t BACTERIOLOGICAL ANALYSES f| ORGANIC POTABLE ANALYSES C ORGANIC NONPOTABLE/SOLID ANALYSES Laba: (circletests) 22;. (circle , 110 Labitests) **, 721X 2er0299 «' ) . . 1. Heterotroph® Plate £ — ? ■ 1. Trihalomethanes (524) 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. 0 7 6. Pesticides (507) .. 6, PCB’s (Arochlors) (608/8080) 6. Macroscopic . : :1 - 7. Pesticides/PCB screen(508) 7. Herbicides (SM-18/6640; 8151) 8. PCB as Decachlorobiphenyl (508A) 8. Other Pesticides (SM-18/6630) her: ** 9. Herbicides (515) 9. Petroleum Hydrocarbon Scan (310-13) 10. Pesticides (525) . 10. Glycols in Water Refrigerated? ves _no 11. Carbamate Pesticides (531) 11. Add Extractables (625/8270) 12. Glyphosate (547) 12. Base Neutral Extractables (625/8270) Chlorinated?: ves . 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) N y

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INORGANIC ANALYSES REQUESTED - Lab#:. (circle tests) 1. Color 20. Acidity 39. Aluminum 59. Potassium 2. T urbidity 21. Alkalinity, as CaCOs 40. Antimony 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) 8. Carbonaceous BOD (5 day) 9. Chemical Oxygen Demand 10. Dissolved Oxygen 26. Fluoride 27. Hardness, Total as CaCOs 28. Nitrogen, Ammonia as N 29. Nitrogen, Nitrate as N 45. Cadmium 46. Calcium, as CaCOs 47. Calcium, Ca*2 48. Chromium, Total 65. Zinc 0~) CLP 1d 66. Metals/CN 67. Volatiles 1/ + 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 GSolids, Settleable 33. Phenol 52. Iron ICLE ‘ Solids, Suspended 34. Phosphorus. Total as P 53. Lead 71. TCLP-Metais 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_________ _ ... z ... . .. ...... 7 k. NYC-WTC_000026440