Chain of custody record, Westchester County Lab, Oct 2001

NYC 9/11 Public Portal Document

UE IL ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH X 2 Dana Road, Valhalla, New York 10595 (914) 593-5575 NYS-ELAP No. 10108 Time/DateSet:___________________ c - 1359 .. - Form A-70 (rev. 1/96) r t.5, • it .9 r .2/8 Cple Type (circle one): 7- 17o , . . ( Potabie - 3. Non-Potable Treated Bottle #©e*A,*’. 2. Non-Potable 4. Other __________ Chain of Custody? .yes .no Time/Date Collected: /oloft ?: 43 Collected ByBol***** Agency Code: Comments: PWS #:_________ Source ID: .Type Descriptor.. Collected From: Bill to. Location’s/Individual’s Name t Name/Company Street_____________________________________ Street__________ City/St/Zip__________________________________ City/St/Zip______ Identification of Source ____________________ Phone#:_ -Fax #: Collection Point, } V 55 CA, CH, BI? Check#: Amounts.

BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLE/SOLID ANALYSES Lab#::____________________ Lab#:----------- - (circle tests) (circle tests) 2" (. 1 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) r. » 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. Organochlorine Pesticides (608/8080) 5. Microscopic 6. Pesticides (507) , 6. PCB’s (Arochlors) (608/8080) 1*% ? f 6. Macroscopic 7) Pesticides/PCB screen (508) 7. Herbicides (SM-18/6640; 81 51) 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) 3.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. .AA l. t !i 4.t INORGANIC ANALYSES REQUESTED - Lab#:. (circle tests) i v: 1. Color 59. Potassium-; 4 20. Acidity 39. Aluminum 2. Turbidity 21. Alkalinity, as CaCOa 40. Antimony 60. Selenium ; 3. pH 22. Bromide 41. Arsenic 61. Silver i 4. Conductivity 23. Bromate/Chlorate/Chlorite 42. Barium 62. Sodium 5. Corrosivity (temp: °C) 24. Chloride 43. Beryllium 63. Thallium ; 6. BOD (5 day) 25. Cyanide 44. Boron 64. Vanadium 7. Soluble BOD (5 day) 26. Fluoride 45. Cadmium 65. Zinc__________ 8. Carbonaceous BOD (5 day) 27. Hardness, Total as CaCOs 46. Calcium, as CaCOa 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 (iolids. Suspended 34. Phosphorus. Total as P 53. Lead 71. TCLP-Metals TSclids. 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 58. Nickel

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