Chain of custody record, Westchester County Lab, Oct 2001

NYC 9/11 Public Portal Document TWTNy

II0 ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 (914)593-5575 NYS-ELAP No. 10108 Te/DateSet:____ Z Form A-70 (rev. 1/96)— Sample Type(circleone): 1. Potable 3. Non-Potable Treated Bottle #‘s: _________ 2. Non-Potable 4. Other _______________ Chain of Custody?____ yes .no Time/Date Collected: I 0 4lolb08 Comments:____________ Collected ByDosowPS Agency Code: PWS#:______ Source ID:, Type Descriptor: Collected From: Bill to: Location's/ndividual's Name. Name/Company. Street______ _ ________ Street_______ City/SVZi _______ _ Identification of Source.___ — Collection Point, 58050 per 30202 Phone#: CA, CH, BI? Fax #: Check#:, Amount$ ... •: BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLE/SOLID ANALYSES Lab#_— (circle tests) 1. Heterotrophic Plate r Count (hemodialysis & all others) Lab #:_____ (circle tests) 1. Trihalome 240/’ thanes (524)' 1. Purgeable Halocarbons (624/8260)

2. Coliform P/A (public supplies) 3. Coliform MPN (priv well, raw, stp) © Volatile Halocarbons (524) Volatile Aromatics (524) 4. Total Trihalomethane Potential (510) 2. Purgeable Aromatics (624/8260) 3. Acrolein & Acrylonitrile (624) 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 (7) Pesticides/PCB screen (508) 7. Herbicides (SM-18/6640; 8151) 7. APi 8. PCB as Decachlorobiphenyl (508A) 8. Other Pesticides (SM-18/6630) her:_________________ 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) Chionnated?:____ yes no 13. Diquat (549) if •’ 14. Chlorination Disinfecti "Byproducts (551) 13.GC/MS Unknown Scan 14. Purgeable Halocarbons (DEF) Free Chlorine Res:. mg/L 15. Haloacetic Acids (552 15. Purgeable. tics (DEF) 16. Other Pesticides (SN 530) 16. Pesticides 17. Petroleum/Hydrocarb, an (310-13) 17. PCB’s (Arc Aitors) (DEF)

P Total Chlorine Res: .mg/L

pH-

INORGANIC ANALYSES REQUESTED - Lab#:. (circle tests) M. 1. Color 20. Acidity 39. Aluminum 59. Potassium 2. Turbidity 21. Alkalinity, as CaCOs 40. Antimony 4 60. Selenium 3. pH 22. Bromide 41. Arsenic 61. Silver -4, -Genductivity--- 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 CaCO3 '46. Calcium, as CaCO3 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 1Solids, Settleable 33. Phenol 52. Iron TCLP Colids, Suspended 34. Phosphorus. Total as P 53, Lead 71. TCLP-Metals 16. Solids, 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 ^5.TCLP-BNA's 58. Nickel ___ _ ._ i - As NYC-WTC_000027357