Chain of custody record, Westchester County Lab, Sep 2001

NYC 9/11 Public Portal Document

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM Westclesten WESTCHESTER COUNTY LABORATORIES AND RESEARCH ’ ‘ gy) 2 Dana Road, Valhalla, New York 10595 914) 593-5575_ NYS-ELAP No. 10108 ime/Date Set: Form A-70 (rev.1/96) RTS07/. 5El‘ Sample Type (circle one): i (vauel 3. Non Potable Treated ,C-O0S,,K 7079 20.3 Q 2t0 2rC8e5/ P-PeG 0 55 r, se vn Bottle #’s: ____ ! ..

2. Non Potable 4. Other___ Chain of Custody?___ yes___ no Time/Date Collected: : 2030 __ /2324 Comments: Collected By: &<rt/m,2220 _ Agency Code:__ PWS #: Source ID: Type Descriptor: 04) c f-ioin re Location’s/Individual’s Name _CDEE Name/Company___ Street 12_ (Je..+ Laks . Do Street_________ City/St/Zip___ Mah Ila _NY. 155 City/St/Zip Identification of Source_____ Phone#:______ ___ Fax#:__ Poin’ - ___ CA.CH, Bl? _ Check/: Amounts *

t ACBHPqXDAACA* ANALYSl ORGANIC rOfABLE ANAI YSS Q.4NU NONPDTA: /S0113 Analysis 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) s. 2. Coliform P/A (public supplies) 3. Coliform MPN (priv well, raw. sip) / 3. Volatile Aromatics (524) 4. Total Trihalomethane Potential (510) 3. Acrolein & Acrylonitrile (624) ■ -4 Phthalates (625/8270) / 4. Fecal Coliform (all samples) 5. Microextractables (504) 75., Organochlorine Pesticides (608/8081) 5. Microscopic . Macroscopic (7./8. Pesti c i d 6-Pesticides (507) es/ PCB casidDecachlP CB screen orobi (508)---------- 6. PCB’s (Arochlors) (608/8081) phenyl (508A) T 19,8, HPesti erbicciiddeses ((SM18/ -.7. Melhoprene (616) - EPA19768/630)8151) _O g __________ _ _ dner: 9. Herbi (10/Pesticides 525) es 515) _ 10. Petroleum Hydrocarbon Scan (310-13) : Refrigerated?____ yes

Chlorinated:?........ yes... no

no 11 Carbamate Pesticides (531) 12. Glyphosate (547) 11. Glycols "====== 9 5-Ui 12. Acid Extractables (625/8270) 13. Diquat (549) 13. Base Neutral Extractables (625/8270) Free Chlorine Res: mg/L 14. Chlorination Disinfection Byproducts (551) 14. GC/MS Semivolatile Unknown Scan Total Chlorine Res: mg/L 15. Haloacetic Acids (552) 15. Purgeable Halocarbons- (DEF)

pH— 16. Pesticides (SM18/6630) 17. Petroleum/Hydrocarbon Scan (310-13) (18. Other e -17.Pesticides/PCB‘s(DEF)=s 16. Purgeable Aromatics (DEF)

18. Other:________ _ _______ .___________ - .

t INORGANIC ANALYSIS REQUESTED - Lab#:.. (circle tests) — Cd 1 Color -- , 20. Acidity 21 Alkalinity, as CaCOa 39.\ Aluminum /De 40. Antimony 5* Potassium 2. Turbidity 60 Selenium 3, pH a 23. 22 Bromide 41. Arsenic 61 Silver ; 4. Conductivity Bromate/Chlorate/Chlorite 42 Barium 43! Beryllium tea.Sodium'... 5. Corrosivity (temp:__ ___ °C) 24. Chloride Thallium 1 6. BOD (5 day) 7. Soluble BOD (5 day) 25. Cyanide .26.Fluoride-9tid 45.Cadmium 44. Boron Vanadium Zinc 8. Carbonaceous BOD (5 day) 27. Hardness, Total as CaCOs" 7 Calcium, Ca'2 46.Calcium, as CaCOa C66.Metals/C LP N 9. Chemical Oxygen Demand 10. Dissolved Oxygen 28. Nitrogen, Ammonia as N 29. Nitrogen, Nitrate as N (48 Chromium, Total 67. Volatiles—he 11. Total Organic Carbon 12. Total Organic Halides — (5510 Cobal 30. Nitrogen, Nitrite as N

32, 011 an Grease t a 31. Nitrogen, Total Kjeldahl as N Copper 49. Chromium, Hexavalent tS Si :n> wad mj 69. Pesticides/PCB’s ■

| ,13. Solids, Percent (%)

Suspen -33. Phenol mnm -3 4. Phosphorus Total as P.omed 70. Disk Deliverables TCLP ; 71 nn%u Total i 3‘> M‘moaptona.,f)nira 36.Sulfates= — i i | // rtfs' redi 1 1 117. Soli i 10 : ; i 10 or Total Di 37. Surfactants--<===- 438.UV254Mssa l co K । 70 DlH tr rs 74 tPMAI,- r ithuis I —

NYC-WTC_000026517