Chain of custody form, Westchester County Labs, undated

NYC 9/11 Public Portal Document wor

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM

IID Time Date Set:___________ WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 (914) 593-5575 NYS-ELAP No. 10108 Form A-70 (rev. 1/96) sple Type (circle one): Z^io, O/S, 3399, 756b, 7729 1 Potable - 3. Non-Potable Treated Bottle ws2239,883/2833,8985, 826 2. Non-Potable 4. Other_____________ Chain of Custody? .yes no Time/Date Collected: 9/24/ 200 / (15l Comments:___ _ Collected By:F bessous (0% Agency Code:. PWS#:_________ .Source ID:. Type Descriptor:. Collected From: Bill to: Location’s/Individual’s Name (uda 5 Name/Company Street____________________ Street__________ City/St/Zip________________ City/St/Zip______ Identification of Sources_______ D& (AB " Phone#:_ 'Fax#:i Collection Point 40/50 r 24361 CA, CH, BI? Check#: Amounts.

BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLE/SOLID ANALYSES Lab#:______________________ Lab #.77 25AX . • * ■ . .4 ' (circle tests) (circle tests) - - \J • — 1 Trihalomethanes (524) i- : ? " . . 4»* 1. Heterotrophic Plate 1. Purgeable Halocarbons (624/8260) a- Count (hemodialysis & all others) 2. Coliform P/A (public supplies) 3. Coliform MPN (priv well, raw, stp) £ Volatile Halocarbons (524) Volatile Aromatics (524) 4. Total Trihalomethane Potential (510) . 2. 3. 4. Purgeable Aromatics (624/8260) 71 Acrolein & Acrylonitrile (624) Phthalates (606/8060) 5? 4. Fecal Coliform (all samples) 5. Microextractables (504) 5. Organochlorine Pesticides (608/8080) t 5. Microscopic -6. Pesticides (507) , 6. PCB’s (Arochlors) (608/8080) 6. Macroscopic (-7. Pesticides/PCB screen (508) , 7. Herbicides (SM-18/6640; 8151) 7. API 8. PCB as Decachlorobiphenyl (508A) 8. Other Pesticides (SM-18/6630) _ 9.Herbicides (515) 9. Petroleum Hydrocarbon Scan (310-13) , 10. Pesticides (525) 10. Glycols in Water Refrigerated?;____ yes no 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

j A INORGANIC ANALYSES REQUESTED - Lab#:. (cicle tests) 1. Color 20. Acidity ----- ys 39. Aluminum — ".... - 59. Potassium C22 • • Car 2. Turbidity 21. Alkalinity, as CaCOs 40. Antimony 60. Selenium 3. pH 22. Bromide 41. Arsenic 61. Silver 4. Conductivity 5. Corrosivity (temp: .°C) 23. Bromate/Chlorate/Chlorite 24. Chloride 42. Barium 43. Beryllium 62. Sodium 63. Thallium 1 /Az, 6. BOD (5 day) 25. Cyanide 44. Boron 64. Vanadium : 7. Soluble BOD (5 day) 26. Fluoride 45. Cadmium 65. Zinc i 8. Carbonaceous BOD (5 day) 27. Hardness, Total as CaCOs 46. Calcium, as CaCOs CLP 9. Chemical Oxygen Demand 28. Nitrogen, Ammonia as N 47. Calcium, Ca*2 66. Metals/CN 10. Dissolved Oxygen 29. Nitrogen, Nitrate as N 48. Chromium, Total 67. Volatiles 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 14. Solids. Settleable 33. Phenol 52. Iron TCLP Colids, Suspended 34. Phosphorus, Total as P 53. Lead 71. TCLP-Metals 18. 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 ■M 58. Nickel -4-a NYC-WTC_000026868