Chain of custody record, Westchester County Lab, Sep 2001

NYC 9/11 Public Portal Document

III ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RFSLARC4 2 Dana Road, Valhalla, New York 10595 l=3st"la=g"y/Gont) 012(914)593-5575_ 1 ) NYS-ELAP No. 10108 ume/Date Set: ■ ; c 24 Form A-70 (rev. 1/96) Gole Tyoe ■■ ■ GrER.eee10010 11 Potable a • Ne-- MMbos }rete i Bottle #’skGaA 2. Non-Potable • Of--i Chain of Custody?_____ yes no Time/Date Collected: (4411/ ■ ->-01___ __ t unment Collected __________________________ Agency Code: PWS #:____ Source ID: Type Descriptor: Collected From R Bill to: / Location’s Individual’s Name__ /IC__ Det__ Name/Company_____ Street______ L " -likal... .... ... Street_...... Crty/St/Zip - ________ _ Crty/St/Zip Identification of Source____ ___________________ __ Phone#:__ _______ Fax#: Collection Pointy _eLb___ j GA, Cn, bi ___ Check#:_____ Amount?.

4*ti i 4 K*i ANALYS: " ONGANC foIA i ANAI *565 (ANiC NPNMOTAN i -ot IDANAYS s Lab#:_______ _________ "LabW-e (circle tests) 1. Heterotrophic Plate —l(circleiests)daera J 1, Trihalomethanes (524) i. Purgeable Halocarbons (624/8260) Count (hemodialysis & all others) U2.2 Volatile Halocarbons (524) 2. Purgeable Aromatics (624/8260) 1 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 . ‘ A 6. Pesticides (507) ; 6. PCB's (Arochlors) (608/8080) 6. Macroscopic ( 7. Pesticides/PCB screen (508) " 7 .Herbicides (SM-18/6640; 8151) 5 T.ARLa i 8. PCB as Decachlorobiphenyl (508A) 8. Other Pesticides (SM-18/6630) 3Ot h er: _ ___ _ _ ____ _____ ( 10. Pesticides (525) n A 9. Herbicides (515) ..9. Petroleum Hydrocarbon Scan (310-13) . 10. Glycols in. Water * : Refrigerated?:_ yes____ no

Chionnated?:___ yes_____ no ■1113. 12. DiGlqyuatphosate (549)(547) v “11. Carbamate Pesticides (531)

Gdm .11. Acid Extractables (625/8270) 12. Base Neutral Extractables (625/8270) 13. GC/MS Unknown Scan 14. Chlorination Disinfection Byproducts (551)i 14. Purgeable Halocarbons (DEF) Free Chlorine Res:_ ... mg/L 15. Haloacet.c Acids (552) 15. Purgeable,Aromatics (DEF) 16. Other Pesticides (SM-18/6630) 16. Pesticides (DEF) Total Chlorine Res: _ _g/L 17. Petroleum/Hydrocarbon Scan (310-13) 17. PCB's (Arochlors) (DEF)

Mxilane PH___ aa" i'.-./ ar ANAI v . s 14 cn Si D ;. N (circle tests) == ======5============ 1652 YO— -1. Colona 2. Tuibidity 20. Acidity ,21. Alkalinity, as CaCO3 /391 Aluminum 40 Antimony /*—*59. Potassium . • ho. Selenium 3.pHGa 4. Conductivity 5. Corrosivity (temp:____ _OC) 22. Bromide 23. Bromate/Chlorate/Chiorite .24. Chloride 3 Arsenic Barium Beryllium _61 Silver 2/62 Sodium 63/ Thallium V 6. BOD (5 day) 25. Cyanide 44. Boron 64i Vanadium 7. Soluble BOD (5 day) 26. Fluoride (45 Cadmium (65. Zinc . 8. Carbonaceous BOD (5 day) 27. Hardness, Total as CaCOa , 46. Calcium, as CaCOa (47 Calcium, Ca+2 CLP 9. Chemical Oxygen Demand 28. Nitrogen, Ammonia as N 66. Metals/CN 10. Dissolved Oxygen 11. Total Organic Carbon 29. Nitrogen, Nitrate as N 30. Nitrogen, Nitrite as N (48. Chromium, Total 49. Chromium, Hexavalent 67. Volatiles " 68. Semi-volatiles 12. Total Organic Halides 31. Nitrogen, Total Kjeldahl as N (50 Cobalt 69. Pesticides/PCB's 13. Solids, Percent (%) 14 Solids, Settleable ! 33. Phenol “ be Lead 32. Oil and Grease

34.Phosphorus.IotalasPl 5352 Iron 51 Copper TCLP_ns 70. Disk Deliverables

t 1 35. Phosphorus, Ortho as Ps 54 Magnesium .71. TCLP-Metals 72. TCLP-Pesticides —36. Sulfates id Manganese 18. Sol i d s. Tot al Vol a 17. Solids, Total Dissolved

19.Other.bnsa 38.1IV254 ti l e d -.37, Surfactants — . 56.Mercuryed ■ 57 Molybdenum a 55 74.TCLP-Volatiles 73. TCLP-Herbicides

7 IPINA

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