Chain of custody record, Westchester County Lab, Oct 2001

NYC 9/11 Public Portal Document

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM

III Te/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) Sample Type (circle one): A re 4 79 2.2, 42 74 ■ *. -7 ? v 98 1. Potable 3. Non-Potable Treated Bottle ys: 873/ SS8/ 224, /C? 776 * 2. Non-Potable 4. Other ________________ Chain of Custody?_____ yes .no Time/Date Collected: _ o/s /or 1051 Comments:_____________ Collected By: C . C P, fik Agency Code: PWS#:______ .Source ID:. Type Descriptor: Collected From: Bill to: Location’s/Individual’s Name. Sk Name/Company. Street_________________ _ Street________ City/St/Zip______________ City/St/Zip Identification of Source.__________ seP# Phone#:_ Fax#:. Collection Pointi 2"75° 30329 CA,CH, BI?. Check#: Amounts. ... • BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLE/SOLID ANALYSES Lab#:. Lab #:----- 6L (circle tests) f | 5 . (circle tests) i 1. Heterotrophic Plate 1. Trihalomethanes (524) 1. Purgeable Halocarbons (624/8260) Counfthemodialysis & all others) /2.) Volatile Halocarbons (524) 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) Pesticides (507) 6. PCB's (Arochlors) (608/8080) 5. Microscopic 6. Macroscopic 6 Pesticides/PCB screen (508) 8. PCB as Decachlorobiphenyl (SOSA) 7. Herbicides (SM-18/6640; 8151) 8. Other Pesticides (SM-18/6630) Gnar _______ 9. Herbicides (515) 9. Petroleum Hydrocarbon Scan (310-13) 10) Pesticides (525) 10. Glycols in Water Refrigerated? _____ 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) (13.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)

pHe INORGANIC ANALYSES REQUESTED - Lab#:. (circle tests) 1. Color 20. Acidity 39. Aluminum N 59. Potassium 2. T urbidity 21. Alkalinity, as CaCOs 40. Antimony 60. Selenium 3. pH 22. Bromide 41. Arsenic 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 CaCOs 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 Solids, Percent (%) 32. Oil and Grease 51. Copper 70. Disk Deliverables U Solids, Settleable 33. Phenol 52. Iron TCLP 15. Solids. 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 _=== waakdasyoitic NYC-WTC_000027442