Chain of custody record, Westchester County Labs, undated

NYC 9/11 Public Portal Document

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM

III Westchester County WESTOHr STI COUNTY I ABORATORIEG AND HESEARCH

0(914)593-5575 2 Dana Road, Valhalla. New York 10595 NYS-ELAP No. 10108 Form A-70 (rev. 1/96) _ sh/DateSet.____ ,9577 7 102 Sample Type (circle one): , H 6*7 1 ‘ Bott le #‘sad L s9 , 6 TO 7 0, 7$18, PT C 7) 1. Potable i 3. Non-Potable Treated n.. mpnaymas 6. ‘T l ’ -2.Non-Potable 4. Other Chain of Custody? yes no T ime/Date Collected: _ 2// Comments:.............. ?

Collected By JJ .Agency Code:__ PWS *_ ... _Source ID:______ Type Descriptor:___ Collected From: Bill to: Location ‘s/n dividual’s Name. A/AArk Na m e /C o mp a n y___ Street.. _...._ -...._ /A/zl 07,) Street —.... .............

zl slle Identification of Source. ! Collection Point / y /£ =======: .=—... — __ _ h&N&K“P- .... _Fax # _.............................. CA,CH. BP... _.... _ . Check#: Amounts___

BACTERIOLOGICAL ANALYSES “organic POTABLE ANALYSES ORGANIC NONPOTABLE/SOLID ANALYSES i Labet__ _________________ Lab #:____ _ ... _ . -.... ..... ......... I (circle tests) j|J (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) | 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. Organochlonine Pesticides (608/8080) 5. Microscopic 6. Pesticides (507) 6 -PCB’s (Arochlors) (608/8080) 6. Macroscopic (2 Pesticides/PCB screen (508) 7* Herbicides (SM-18/6640; 8151) ARI 8. PCB as Decachlorobiphenyl (508A) 8? Other Pesticides (SM-18/6630) therm 9. Herbicides (515) 9. Petroleum Hydrocarbon Scan (310-13) <10Pesticides (525) 10. Glycols in Water Refrigerated?_____ _______ 11. Carbamate Pesticides (531) 11. Acid Extractables (625/8270) 12. Glyphosate (547) 12. Base Neutral Extractables (625/8270) Chlorinated?:___ yes_____ no 13. Diquat (549) 13. GC/MS Unknown Scan 14. Chlorination Disinfection Byproducts (551) 14. Purgeable Halocarbons (DEF) Free Chlorine 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)

_pH_. //— / INORGANIC ANALYSES REQUESTED - Lab#: t 4, (circle tests) I. Color 20. Acidity ; 39. Aluminum ' 40, Antimony 7 59^i Potassium : 60. Selenium : 5 Turbidity 21. Alkalinity, as CaCOj oH 22. Bromide | 411 Arsenic : 61. Silver ! 4, Conductivity 23. Bromate/Chlorate/Chlorite | 42. Barium J 62. Sodium : 13. Beryliium 5, Corrosivity (temp: _ C) 24. Chloride ; 63. Thallium 6. BOD (5 day) 25. Cyanide 44. Boron f 64. Vanadium 7, Soluble BOD (5 day) 26. Fluoride 15 Cadmium 165/Zinc_______ 8 Carbonaceous BOD (5 day) 9. Chemical Oxygen Demand 10. Dissolved Oxygen 27. Hardness, Total as CaCOa 28. Nitrogen, Ammonia as N 29. Nitrogen, Nitrate as N 46. Calcium, as CaCOa ,47)Calcium, Cat (48: Chromium, Total CLP ’ 66. Metals/CN 67. Volatiles 11. Total Organic Carbon 30. Nitrogen, Nitrite as N 49. Chromium, Hexavalent 68. Semi-volatiles j 12. Totai Organic Halides 31. Nitrogen, Total Kjeldahl as N \ 50, Cobalt 69. Pesticides/PCB’s ; 3. Solids, Petcent (%) 32 Oi and Grease 51!Copper 70. Disk Deliverables Solids, Settleable Solids. Suspended 33. Phenol 34. Phosphorus, Total as P 53! Lead 52 irone "TCLP ' “ 71, TCLP-Metals 16 Sclids, Total 17. Solids, Total Dissolved 35 Phosphorus, Ortho as P 36. Sulfates 55 Manganese 54 Magnesium 72. TCLP-Pesticides 73. TCLP-Herbicides 18. Sohds. Total Volatile 37. Surfactants !t bo Mercury 74. TCLP-Volatiles 19. Other: <A 3 38.UV254l 57, Molybdenum 75, TCLP-BNA’s 58 Nickel

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