Chain of custody record, Westchester County Lab, Oct 2001

NYC 9/11 Public Portal Document

III ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 C (914) 593-5575 NYS-ELAP No. 10108 T Date Set:____________________ _______ L6t6, 671,73 • Form A-70 (rev. 1/96)— Sample Type (circle one): 1.Potable 2. Non-Potable . 3. Non-Potable Treated 4. Other. » _______ R smbilW)”ktai"1. Chain of Custody? yes no Time/Date Colected:. . _o\sl ol T3 Comments: Collected By- econadencv Code: PWS #:______ __ .Source ID:. Type Descriptor.. Collected From: 1 X Bill to: Location’s/Individual’s Name, Vly Name/Company Street_______________ ? Street__________ City/St/Zip___________ City/St/Zip______ Phone#:._______ RsE Identification of Source_. -Fax #: Collection Point CA,CH, BI?, Check#: Amounts.

BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLE/SOLID ANALYSES Lab#:__________ (circle tests) 1. Heterotrophic Plate ' nb.t-,O434—— 1 Trihalomethanes(524) / C 2 Volatile Halocarbons (524) . 1. Purgeable Halocarbons (624/8260) Count (hemodialysis & all others) 2. Purgeable Aromatics (624/8260) 2. Coliform 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) 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) ; 8. PCB as Decachlorobiphenyl (SOSA) Gen __ ~ 7. API 9. Herbicides (515) (10) Pesticides (525) 8. Other Pesticides (SM-18/6630) 9. Petroleum Hydrocarbon Scan (310-13) 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

INORGANIC ANALYSES REQUESTED - Lab#:. (circle testa)' 1. 2. 3. Color T urbidity pH 20. Acidity 21. Alkalinity, as CaCOs 22. Bromide 39. Aluminum 40. Antimony 41. Arsenic v J •2 59. Potassium 60. Selenium 61. Silver 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 1golids, Settleable 33. Phenol 52. Iron TCLP 1Mblids, 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 75. TCLP-BNA’s 58. Nickel

NYC-WTC_000027362