Chain of custody record, Westchester County Lab, Oct 2001

NYC 9/11 Public Portal Document

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM

III 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) (ple Type (circle one): 1 .Potable 3. Non-Potable Treated Bottle #‘s_ S*f . * 2. Non-Potable 4. Other_____________ Chain of Custody? yes no Time/Date Collected: 10/1/200f 224 A Comments: Collected By: • i Agency Code:. PWS#:_________ .Source ID:. .Type Descriptor:. Collected From: Bill to: Location’s/Individual’s Name. K Name/Company Street__________________ Street__________ City/St/Zip_______________ City/St/Zio Identification of Source .______ Phone#:_ Fax#: Collection Point,. 310 SO CA, CH, BI? Check#: Amounts.

BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES C ORGANIC NONPOTABLE/SOLID ANALYSES Lab#:____________________ Lab #:_______ —1 (circle tests) (circle tests) > 1 — / C 1. Heterotrophic Plate 1. Trihalomethanes (524) 1. Purgeable Halocarbons (624/8260) Volatile Halocarbons (524) 2. Purgeable Aromatics (624/8260) Count (hemodialysis & all others) 2. Coliform P/A (public supplies) 3. Coliform MPN (priv well, raw, stp) ©4. Total Trihalomethane Potential (510) Volatile Aromatics (524) 3. Acrolein & Acrylonitrile (624) 4. Phthalates (606/8060) 5. Microextractables (504) 5. Organochlorine Pesticides (608/8080) 23 4. Fecal Coliform (all samples) 5. Microscopic 6 Pesticides (507) 6. PCB’s (Arochlors) (608/8080) 6. Macroscopic (.) Pesticides/PCB screen (508) 7. Herbicides (SM-18/6640; 8151) 7. API 8. PCB as Decachlorobiphenyi (508A) 8. Other Pesticides (SM-18/6630) s 8. Other:___________________ 9. Herbicides (515) 9. Petroleum Hydrocarbon Scan (310-13) - MMgaratac? 10.Pesticides (525) 10. Glycols in Water yes no 11. Carbamate Pesticides (531) 11. Acid Extractables (625/8270) 12. Glyphosate (547) 12. Base Neutral Extractables (625/8270) Th 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 • 17. Petroleum/Hydrocarbon Scan (310-13) 17. PCB’s (Arochlors) (DEF)

pH ; % INORGANIC ANALYSES REQUESTED" Lab#: (circle tests) s tisil CD ■ - 1. Color 20. Acidity 39. Aluminum 59. Potassium a 5$ 2. Turbidity 21. Alkalinity, as CaCOa 40. Antimony 60. Selenium 3. pH 22. Bromide 41. Arsenic 61. Silver 4. Conductivity 23. Bromate/Chlorate/Chiorite 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 CaCOa 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 Solids, Suspended 34. Phosphorus. Total as P 53. Lead 71. TCLP-Metals 1olids, 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 atoii tcJtssabsintsterablnck NYC-WTC_000027194