Chain of custody record, Westchester County Lab, Oct 2001

NYC 9/11 Public Portal Document

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Jenchertercoury ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 , (914) 593-5575 NYSELAR) A o. 10108 yif S, “he/Date Set:_______ FollA-79 ave196), Sample Type (circle one): 1. Potable 3. Non-Potabie Treated Bottle wefA 3 0 L v / 7 fz IM W S7 . 4h st 28 73 ’ ..P* .ge % ye - t 2. Non-Potable 4. Other____________ Time/Date Collected: I DI 5/ Ci Collected By: - Agency Code:. I DO I Chain oLBustody? Comment: PWsat .yes

.Source ID:. no Mar _ Type Desoriptol 4. ovt ’ rt

Collected From: Location’s/Individual’s N; C we j $ ... Bill5*. to “ Name/Company. P %.

Street________ Street ** 1% City/St/Zip Identification of' L, peti Ciy/SVZip Phone#:, 14. ‘Fax #: Collection Point / 51750 Zo®So CA, CH, BI?. ‘ Check#: Amounts f i t" y BAGTEBIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLE/SOLID ANALYSES Lab#: m (circle tests). J | 1. Heterotrophic Plate f Lab#: (circle tests) 2411/17 1. Trihalomethanes (524) ' # a $ * 1. Purgeable Halocarbons (624/8260) ... g s Count (hemodialysis & all others) 2.2 Volatile Halocarbons (524) 2. Purgeable Aromatics (624/8260) h 2. Coliform P/A (public supplies) ' 3. Volatile Aromatics (524) 3. Acrolein & Acrylonitrile (624) 2 sa 3. Coliform MPN (priv well, raw, stp) 4. Total Trihalomethane Potential (510) Phthalates (606/8060) 4.5. Organochlorine s3-cam Pesticides (608/808. 4. Fecal Coliform (all samples) 5. Microextractables (504) 5. Microscopic 6. Pesticides (507) 6. PCB’s (Arochlors) (608/8080) eng 6. Macroscopic 2 Pesticides/PCB screen (508) 7. Herbicides (SM-18/6640; 8151) sbi 8. Other Pesticides (SM-18/6630V Aa GP _ _____________________ _ 8. PCB as Decachlorobiphenyl (508A) 9. Herbicides (515) (10. Pesticides (525) • "d - 9. Petroleum Hydrocarbon Scan (31 10. Glycols inWater ‘$ Refrigerated? ,es no 11. Carbamate Pesticides (531) 11. Acid Extractables (625/8270) $ 12. Glyphosate (547) $t 12, Base Neutral Extractables (625/82 13 GC/MS Unknown Scan Chlorinated?: .yes no 13. Diquat (549) S4 Free Chlorine Res:. mg/L

.mg/L 14. Chlorination Disinfection Byproducts (551) 15. Haloacetic Acids (552) 16. Other Pesticides (SM-18/6630) 17. Petroleum/Hydrocarbon Scan (310-13) 14. Purgeable Halocarbons (DEF) 15. Purgeable Aromatics (DEF) 18. Pesticides (DEF) 17. PCB’s (Arochlors) (DEF) C) Total Chlorine Res: 2 pH- . 4 _ ___________

INORGANIC ANALYSES REQUESTED - Lab#:. (circle tests) 1. Color 20. Acidity 39. Aluminum J/; ,59 .Potassium 2. Turbidity 21. Alkalinity, as CaCOs 40. Antimony ' 60. Selenium 3. pH 22. Bromide 41. Arsenic / 61. Silver $ 4. Conductivity 23. Bromate/Chlorate/Chlorite 42. Barium s 62. Sodium 5 5. Corrosivity (temp: °C) 24. Chloride 43. Beryllium • i ‘ *-63. Thallium . „ 6. BOD (5 day) . 25. Cyanide 44. Boron 64. Vanadium? ' 7. Soluble BOD (5 day) 26. Fluoride 45. Cadmium 3 65. Zinc_______________ 8. Carbonaceous BOD (5 day) 27. Hardness, Total as CaCOs 46. Calcium, as CaCOs 2 CLP t ' ' 9. Chemical Oxygen Demand 28. Nitrogen, Ammonia as N 47. Calcium, Cat ee 66. Metals/CN y V 10. Dissolved Oxygen 29. Nitrogen, Nitrate as N 48. Chromiumggotal,— 67. Volatiles [ wt 11. Total Organic Carbon 30. Nitrogen, Nitrite as N 49. Chromiunt Hexavalent . 68. Semi-volatiles ' ‘ 12. Total Organic Halides 31. Nitrogen, Total Kjeldahl as N 50. Cobalt a - 1 69. Pesticides/PCB’s • Solids, Percent (%) 32. Oil and Grease 51. Copper $* i 70. Disk Deliverables W Solids, Settleable 33. Phenol 52. Iron M• TCLP 15. Solids. Suspended 34. Phosphorus, Total as P 53. Lead #* 71. TCLP-Metals 16. Solids, Total 35. Phosphorus, Ortho as P 36. Sulfates" 54. Magnesiuf 5** * 55. ManganesEit 72. TCLP-Pesticides 73. TCLP-Herbicides 17. Solids, Total Dissolved 18. Solids. Total Volatile 37. Surfactants 56. Mercury 74. TCLP-Volatiles 19. Other:_________________ 38. UV254 57. Molybdenumke t 75. TCLP-BNA’s i 58. Nickel y ' " • ___ ! T g*

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