Chain of custody record, Westchester County Lab, Oct 2001

NYC 9/11 Public Portal Document

Hl ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH 4 2 Dana Road, Valhalla, New York 10595 Uestchester County 914 593-5575 e NYS-ELAP No. 10108 Ame/Date Set: I o i.i A 0 zrov. 1/903

Sample Type (circle one): 0vc,63 1022,’A*O,5523,K639 : 0.1, 3. Non-Potable Treated Bottle #s?©b) CEACtg _ec3\GD2_ 2. otable 4. Other Chain of Custody? cs no k5105 V’’

Time/Date Collected: Ore / 16- 3-Q Comments }

Col ected Bw D.Sco1 Agency Code: PWS #:______________ Source ID: Type Descriptor: Collected From: Bil to — Location’s/Individual’s Name 22 Name/Company Street ILWesLA.C/ Street_......... ................. City/St/Zip. identification of Source ■ Crty/Sv/Zip_ Phone*: __ _ Fax Collection Point D6UO [ CA, CH, B?.......... Check#:___ Amount?.

BACTERIOLOGICAL ANALYSES ’ ORGANIC POTABLE ANALYSES 1....... .. ORGANIC NONPOTABLE/SOLID ANALYSES*! Lab#:______________________ Lab #:__________________ _____ Teeeeee (circle tests) (Circle tests) 1. Heterotrophic Plate 1., Trihalomethanes (524) 1. Purgeable Halocarbons (624/8260) 2.) Volatile Halocarbons (524) 2. Purgeable Aromatics (624/8260) Count (hemodialysis & all others) 2. Cohtorm P/A (public supplies) 3) Volatile Aromatics (524) 3. Acrolein & Acrylonitrile (624) ! 3. Coliform MPN (priv well, raw, stp) 4. Total Trihalomethane Potential (510) 4. Phthalates (606/8060) i 4. Fecal Coliform (ail samples) 5. Microextractabies (504) 5. Organochlorine Pesticides (608/8080) : : 5. Microscopic 6. Pesticides (507) 6. - PCB’s (Arochlors) (608/8080) - "' 6. Macroscopic (2) Pesticides/PCB screen (508) 7* Herbicides (SM-18/6640; 8151) — ARL her 8. PCB as Decachlorobiphenyl (508A) 9. Herbicides (515) & Other Pesticides (SM-18/6630) !’ ■ : oum Hlydrocothpp an 09)0 13) . 10JPesticides (525) 10. Glycols in Water 11. Acid Extractables (625/8270) ---=d"=>= Refrcerated? yes ri . 11. Carbamate Pesticides (531) 12. Glyphosate (547) 1" . Aeulipilatatablg(622:/8*/0) Chlorinated?:yes_____ no 13. Diquat (549) £13,GC/MS Unknown Scan rs . 14. Chlorination Disinfection Byproducts (551) 14. Purgeable Halocarbons (DEF7) Free Chlorine Res: __ mg/L ■ 15. Haloacetic Acids (552) 15. Purgeable Aromatics (DEF) 16. Other Pesticides (SM-18/6630) 16 Pesticides (DEF) Total Ch’orine Res:_________ mg/L 17: Petroleum/Hydrocarbon Scan (310-13) 17. PCB's (Arochlors) (DEF)

pH. _= INORGANIC ANALYSES REQUESTED - Lab#:_ (circle tests) — I 1. Color 20. Acidity 39. Aluminum 59. Potassium I 112, Turbidite 21. Alkalinity, as CaCO?, (40, Antimony 60. Selenium 3oHM 4. Conductivity 22. Bromide 23. Bromate/Chlorate/Chlorite 41. Arsenic 42. Barium 61. Silver 62. -*** Sodium 5. Corrosivity (temp;______ °C) 24. Chloride (43) Beryllium 63. Thallium 6. BOD (5 day) 25. Cyanide 44. Boron ; 4 V.i i.'Jium 1 I 7. Soluble BOD (5 day) 26. Fluoride 45. Cadmium 65, Zinc 8. Carbonaceous BOD (5 day) 27. Hardness, Total as CaCO3 46. Calcium, as CaCOa CLP IL I i 9. Chemical Oxygen Demand 10. Dissolved Oxygen 11. Total Organic Carbon 28. Nitrogen, Ammonia as N 29. Nitrogen, Nitrate as N . . 30. Nitrogen, Nitrite as N 47. Calcium, Ca*2 48. Chromium, Total 49, Chromium. Hexavalent 67. Volatiles Mer/CN

68. Semi-volatiles - 12. Total Organic Halides 31. Nitrogen, Total Kjeldahl as N (50. Cobalt 6) Pesticpl . 13. Solids, Percent (%) 32. 011 and Grease - 51. Copper A Ds.k ra iv>i. g * we htc. -p* od 33_Phenol 52. Iron " TCLP

116Solids 17. Solids, Total Dissolved- 36. Sulfates Total . 14 Ph splion . I v tn' I •• ■ ■ 35. Phosphorus, Ortho as P 53. Lead 54. Magnesium 1 TOI M- / QPPedeo,

Solids, LotalnVol 11 8,9 other —T atile l637. Surfactants _ "38.UV254 55. Manganese 56. Mercury a (5Z-Molybdenum 73:TCLP-Herbicides 74 BV-ire 75 IC I RNA 58. Nickel

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