Chain of custody record, Westchester County Lab, Sep 2001

NYC 9/11 Public Portal Document

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM ster WESTCHESTER COUNTY LABORATORIES AND RESEARCH t 80.6* 2 Dana Road, Valhalla, New York 10595 _914) 593-5575 das NYS-ELAP No. 10108 'Date Set: I Kr-2al____ Form A-70 (rev. 1/96) plpc 3,P68-F323,d-2039,**7662,1770. Sample Type (circle one): a* ■ ■'•tori i... i si. ■ h>'. th d Bot le #s: Q-Bbis c-2LW0B & P-8687, 2. Non Potable 4. Other Chain of Custody?___ yes____ no Time/Date Collected: 2293, ) ,/ 2-mimhepit; Collected By: sEAMAlPd Agency Code:___ PWS #:_______ Source ID: Type Descriptor; Caalion tec Fscys Bill to: Location’s/Individual’s Name __ i ! ! Name/Company Street... II... tilakc Da__ Street______ City/St/Zip _lhllA 1 I City/St/Zip Identification of Source______ Phonef: rFax#: Collection Point... CR - . 2:: Bl Check#:_ Amsing

HACH US—DOCTCAL AAtYSS ORGANIC POTABLt ANALYNS OKAN:C NONPOTAELESDL ANAI YSI2 Lab#: Lab# (circle tests) (circle tests) 1. Heterotrophic Plate 1. Trihalomethanes (524) 1. Purgeable Halocarbons (624/8260) Count (hemodialysis & all others) ‘2, Volatile Halocarbons (524) 2. Purgeable Aromatics (624/8260) - T }3, Volatile Aromatics (524) . 2. Coliform P/A (public supplies) 3. Coliform MPN (privwell, raw. stp) 4. Fecal Coliform (all samples) 4.Phthalat 5. Organochl M. Total Trihalomethane Potential (510) esori(625/ n e 8270) :3, Acrolein & Acrylonitrile (624).

Pesti cides8081)(608/8081) 5. Microscopic — 56. Pesticides (507) .6. 5. Microextractables (504) PCB ’s :7.Methoprene(616) (7.) Pesticides/PCB screen (508) (Arochl o rs) (608/ 503 8. Other:_ ___________ Herbiccidideses (EPA1978/8151MA 18,9, Pesti 5. “‘Cl .. . Po oicreiapil pi s ‘A) 9. Herbicides (515) SM18/6630) Ms Refrigerated?____ yes ....no

Chlorinated:? ____ yes____ no (10‘ Pesticides (525) 11.12. GlAcidycolExtractables rl. Carbamate Pesticides (531) 12. Glyphosate (547) s --------r t 1.

(625/8270) 1 ’ MIHbfcn (0 1'.: ! i i 13. Diquat (549) 13. Base Neutral Extractables (625/8270) Free Chlorine Res: ___ mg/L i 14. Chlorination Disinfection Byproducts (551) 14. GC/MS Semivolatile Unknown Scan Total Chlorine Res:________ mg/i 15. Haloacetic Acids (552) 16. Pesticides (SM18/6630) 16.17. Pesticides/PCB Purgeable Aromati cs (DEF) • 2-. 15. Purgeable Halocarbons (DEF)

’s (DEF)

n pH __ 17. Petroleum/Hydrocarbon Scan (310-13) 18. Other:____________________________ _ 18. others___ INORGANIC ANALYSIS REGUESTEC -: :1; ■ (circle tests) 1. Color : --{--9-94 — 20. Acidity ------- 89. Aluminum I 2. Turbidity . 3.H_ 21. Alkalinity, as CaCO3 — 22. Bromide ' 40. Antimony. 41 Arsenic 2 Selenium Silver 4. Conductivity 23. Bromate/Chlorate/Chlorite 42 J Barium 62. Sodium 24.Choride-?--)4 143 Beryllium Thallium 5. Cyanide 44.Boron 5. Corrosivity (temp:____ A°C) 63. 2 - 6. BOD (5 day) . 7. Soluble BOD (5 day) „ 26.Fluorde- 46.45, CalCadmicium,umast CaCOsd 64. Vanadium 65 Zinc = 8. Carbonaceous BOD (5 day) 27. Hardness, Total as CaCOa 47) Cal c i u m, Ca ” ad] CLPela 66.Metals/CNl 10. Di s sol v ed 9. Chemical Oxygen Demand Oxygen t 7 29, 28. Nitrogen, Ammonia as N

,30. Ni Ni t t rogen, rogen, Nitrate Ni t r i t e as as NN__d 48. Chromi 49. Cobal u m, Total Chromit um, mhilo Hexavalent 67.olatiles_ 11, Tot a l Organi c Carbon c Hali%) _ des a )a32. Oil an Grease 60 68. Semi violatiles "$ 12, SolTotaidls,Oraani 31. Nitrogen, Total Kjeldahl as N 13,gec Percent 33. Phenol ..." Iron ■-1 Cop; ■■ nolrostrids/CBs 0 Di-h Delosanlt faiic 1 7 34. Phosphorus, Phosphorus TotOrtahl oasasP 53 Lead TCLPMA 71TCLP-Metals • 16.17. SolSoliidds.s, TotTotaall_= Di s solv ed a 2135. 136. Sul f ates P taad 54 Manganese Magnesium igs 72.TOLP-Pesticidesi Surfactants--")a 57 Molybdenum ■ 73,TOLP-Herbicides Solids, Totnal Volatilea 19.18. Other im 37. 38.UV254_s 56. Mercury t 58. Nickel Ma.L . : ICLL-Velees /- TOI-HNA-,

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