Chain of custody form, Westchester County Labs, undated

NYC 9/11 Public Portal Document

ENVIRONMENT Ai. StBVICES SAMPLE SUEMISSION FORM WEST CHE ST LR COUNTY I ABORATOSIL $ AND Pred ARcil 2 Dana Road. Valhalla, New York 10595 Ulestchester County _e(914) 593-5 75 _ NYS-ELAP No. ' lime/Date Set: ________ _ F or mA - 70 (rev. 1/96) Sample Type (circle one): “76 0. Potable- ‘ ?. Nen l a l|< ■ lls- lii'i Bottle #’s:___________ __ ______ 2. Non-Potable 4. Other: Chain of Custody? _.... .... yes __ ___ no Time/Date Collected:____ I-7k2 Comments: * ■ Collected Bye_ :__&______ __ Agency Code..._ PWS# Source ID' Tyne Descriptor: Collected From: BUI to: Log at i o n’s.’In div idual s N a m e_ ; N a me/C omp a n y Street....... ....... __ . _ _ Street_____ City/StZip. _____ _ __ ________ City/St/Zip____ Identification of Source______ ; Phonet. ..Fax#: WNWWGe/ Collection Point___ _2 : _ .. CA, CH. BI?.. Check#:....... _ Amount?

cAmt a.n c-.! - ■ • ANAS Y5 I N (NtAH lPod * ARA Yii ()9 AC NNl*s AB i / ■; IP ANAI Y;-t > Lab#:_ Ncircle tests) ddaeetete Lab # Km -(circle tests) — 1. Heterotrophic Plate Trihalomethanes (524) 1. Purgeable Halocarbons (624/8260) Count (hemodialysis & all others) () Volatile Halocarbons (524) 2. Purgeable Aromatics (624/8260) 2 Coliform P/A (public supplies) Volatile Aromatics (524) 3. Acrolein & Acrylonitrile (624) ) 3. Coliform MPN (pi iv well, raw, stp) i 4. Total Trihalomethane Potential (510) 4. Phthalates (606/8060) 4. fecal Coliform (all samples) ; 5. Microextractables (504) 5. Organochlorine Pesticides (600/8080) 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.AP Othe—r ; .8. PCB as Decachlorobiphenyl (508A) i 9. Herbicides (515) 8. .Other Pesticides (SM-18/6630) "9, Petroleum Hydrocarbon Scan (310-13) (10Pesticides (525) 10. Glycols in Water Refrigerated?__ yes...... ... no I 11. Carbamate Pesticides (531) 11. Acid Extractables (625/8270) : 12. Glyphosate (547) 12. Base Neutral Extractables (625/8270) Chionnated'’:___ .yes_____ no 13, Diquat (549) 13. GC/MS Unknown Scan . 14. Chlorination Disinfection Byproducts (551)। 14. Purgeable Halocarbons (DEF) Free Chionne 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 I 17. Petroleum/Hydrocarbon Scan (310-13) 17. RGB’s (Arochlors) (DEF)

_PH. _

' 1 ‘ 0 ANP. / -i S lit (orole tsts! 10 * ! 0 . . 525 Fplce 1. Color e 20. Acidity 39. Aluminum "'59. Potassium if | 2. Turbidity 21. Alkalinity, as CaCO, 40. Antimony 60. Selenium . 3.PH 4. Conductivity 22. Bromide 23. Bromate/Chiorate/Chlorite 41. Arsenic 42. Barium 61. Silver 62. Sodium V

5. Corrosivity (temp:_ °C) 24. Chloride ; 43/ Beryllium .63 Thallium 6. BOD (5 day) 25. Cyanide 44. Boron t 64. Vanadium 7 Soluble BOD (5 day) 8. Carbonaceous BOD (5 day) 26.Fluonideaeer 27. Hardness. Total as CaCOg 45. Cadmium 46. Calcium, as CaCOa 65.Zinc CLP _ 9. Chemical Oxygen Demand 28. Nitrogen, Ammonia as N 47. Calcium. Ca* 66. Metals/CN 10. Dissolved Oxygen 11 Total Organic Carbon 29. Nitrogen, Nitrate as N ,30. Nitrogen, Nitnte 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 .51. Copper. 13. Solids, Percent (%) 4. Sohds, Settleable 33 Phenol . .52. ron ee 53. ILead 32. 04 and Grease 70. Disk Deliverables TCLP 71.TCLP-Metals 16. Solids, Total nn 36. Sulfates । 15. Solids, Suspended 34. Phosphorus. Total as P

---- .54. Magnesium 35. Phosphorus, Ortho as P . 72.TCLP-Pesticides 18. Other 11119 Solids, TotalTVoleem atile a 38.UV254nbe .56. Manganese 55. 17. Solids. Total Dissolved 37. Surfactants s .57. Mercury a Molybdenum 73. ICLP-Herbicides 174. TCLP-Volatiles 75.TCLP.BNA‘s 58. Nickel" NYC-WTC_000026924