Chain of custody form, Westchester County Labs, undated

NYC 9/11 Public Portal Document

ENVIRCNMENTAL SERVICES : AMPLE SUBMISSION FORM

ill Uestchester County WESTHESTL n COUNTY IAHORATORILS AND RP 1 EARCH

-2914)593-5 75_ 2 Dana Road, Valhalla, New York 10595 S

NYS-ELAP No. 101 P 5 Form A-70 (rev. 1/96) ime/Date Set: —AFE Sample Type (circle one): ( Potable 3. Non-Potable Treated 0861770 Bottle _____________ 242/8162 2.Non- Potable 4. Other _ _ ____ Chain of Custody? yes no i Time/Date Collected: _______ Comments:_______ Collected By_2___ __ . ............ y__ _Agency Code:_ ______ PWS _____________ Source ID:____ __ _Type Descriptor... Collected From: —OBillto! Location’s Individual’s Name J UVC Name/Company Street_D_ :___ __ie At. Street " City/St/Zip _k _...... — et / City/St/Zip Identification of Source__ Phoneh: ______ Fax #: Collection Point J CA, CH. Bi? Check#: Amount?

—.. — _______________________________________ . aActtenomel ANALYSIS ORGANIC Pi al 1 ANAu 18 (14- ANK. Ne NUO{A( * $-,) ID ANAt Yim’s Labim (cicle tests) i Lab # "qummpaoeamata - (circle tests) 2- , - ‘ | : * 1

1. Heterotrophic Plate : 1 Trihalomethanes (524) ■ 1. Purgeable Halocarbons (624/8260) Count (hemodialysis & all others) ′24 Volatile Halocarbons (524) 2. Purgeable Aromatics (624/8260) 2) Coliform P/A (oublic supplies) 3/ Volatile Aromatics (524) 3. Acrolein & Acrylonitrile (624) 3. Coliform MPN (Drv well, raw, stp) ! 4. Total Trhalomethane Potential (510) 4. Phthalates (606/8060) 4. Fecal Coliform (all samples) ; 5. Microextractables (504) 5. Organochlorine Pesticides (608/8080) 5. Microscopic : 6 Pesticides (507) 6. PCB’s (Arochlors) (608/8080) 6. Macroscopic ( 7j Pesticides/PCB screen (508) 74 Herbicides (SM-18/6640; 8151) ZARM 8. PCB as Decachlorobiphenyl (508A) 8. Other Pesticides (SM-18/6630) . . Other 9. Herbicides (515) ( 10; Pesticides (525) 10. Glycols in Water ’9. Petroleum Hydrocarbon Scan (310-13) ■

Refrigerated? ____ yes____ no 1. Carbamate Pesticides (531) %' .11. Acid Extractables (625/8270)

Chionnated?: yes .no j 13. Diquat (549) en 12. Glyphosate (547)

14. Chlorination Disinfection Byproducts (551) 12. Base Neutral Extractables (625/8270) .13. GC/MS Unknown Scan 14. Purgeable Halocarbons (DEF) .

Free Chlorine Res: ___ _ ; 15. Haloacetic Acids (552) 15. Purgeable Aromatics (DEF) | ,16. Other Pesticides (SM-1 8/6630) 16 Pesticides (DEF) .Total Chorine Res: mg/L i 17. Petroleum/Hydrocarbon Scan (310-13) 17. PCB’s (Arochlors) (DEF)

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**4 • Ai,A> vs; sm otpt.0 . * ===== (circle tests) --------------V 1. Color 2. Turbidity 20. Acidity 21. Alkalinity, as CaCOa 39. Aluminum 40. Antimony 2 ■ 59. Potassium'. 60. Selenium . , , ′ ( // 3.H. 22. Bromide 41. Arsenic *X" . 61. Silver 1 4. Conductivity 23. Bromate/Chlorate/Chlorite 42. Barium /: —0 62. Sodium ' . 5. Corrosivity (temp: .... °C) 24. Chloride . 43. Beryllium < 63. Thallium : e. BCD (5 day) 7. Soluble BOD (5 day) 25. Cyanide 26. Fluoride “44. Boron 45. Cadmium ) 64. Vanadium 65. Zinc______ __ ' CLP “ 8. Carbonaceous BOD (5 day) . 9. Chemical Oxygen Demand 27. Hardness, Total as CaCOa 28. Nitrogen, Ammonia as N 48. Chromium, Total " 111.66.Me 46. Calcium, as CaCO 47. Calcium, Ca" . 67. tals/CN Volatiles 10. Dissolved Oxygen 11. T oral Organic Carbon 29. Nitrogen, Nitrate as N 30. Nitrogen, Nitrite as N 68, Semevolatiles _ 50. Cobalt 1/9)927 169.esitides/PCBs 49. Chromium, Hexavalent

13.4. SolSoliidds,s, Percent 12. Total Organic Halides . (%) - 33.Pheno “52.51. ICopper Settleable) 31. Nitrogen, Total Kjeldahl as N 32. O I and Grease r on — =--- 70: Disk jeliverables _

15. Sol i d s, Suspended se 34. Phosphorus. Total as P 53. Lead s IITcLR 71. CRd TOLP Metals . 16.17. Solids, Solids. Total Total Dissolved 1 wa 35. Phosphorus, Ortho as P54. 55. Magnesium Manganese [057 t (72.TCLP-Pesticides —'h 18. Solids.ATdsner 19 Other Total Volatile pch 138.UV254 36. Sulfates ■ : 37 Surfactants 56. Mercury 1474.TCLP-Volatiles.nl (57. Molybdenum 2 raeHctnn Pt IgNNA 158. Nickel NYC-WTC_000027022