Chain of custody record, Westchester County Lab, Oct 2001

NYC 9/11 Public Portal Document

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM

III T/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): 7$72.6624 44400, C9^g 7692 1. Potable .3. Non-Potable Treated pomaw86t0 9623 Ftisn 9699 *s 2. Non-Potable 4. Other _____________________ Chain of Custody? yes .no Time/Date Collected:. //t/o / ___ 051 Comments: Collected By: C « 750* Agency Code: PWS# .Source ID:. .Type Descriptor Collected From: Bill to: Location’s/Individual’s Name P A Name/Company Street________________ __ ________ Street__________ City/St/Zip______________ '________ City/St/Zip Identification of ___________________ BeP # Phone#_ _Fax #: Collection Point 7 4^3 SO 303/2 CA,CH, Bl? Check#: Amounts. tr

BACTERIOLOGICAL ANALYSES J ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLE/SOLID ANALYSES Lab *_ -6199 ■■ Lab#: (circle tests). 8

: (circle tests) A 4 w . 4 . ** s ■ 1: Heterotrophic Plate 1. Trihalomethanes (524)’ 1. Purgeable Halocarbons (624/8260) . Count (hemodialysis & 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 (519) 4. Phthalates (606/8060) 4. Fecal Coliform (all samples) 5. Microextractables (504) 5. Organochlorine Pesticides (608/8080) 5. Microscopic Pesticides (507) a 6. PCB’s (Arochlors) (608/8080) 6. Macroscopic Pesticides/PCB screen (508) 7. Herbicides (SM-18/6640; 8151) 8. PCB as Decachlorobiphenyl (508A) 8. Other Pesticides (SM-18/6630) Cher ‘s 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) 85 12. Glyphosate (547) 12. Base Neutral Extractables (625/8270) Chionnated?: 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 REQUESTEDYLab#: (circle tests) %. e nlatl 59. Potassium 1. Color 20. Acidity 39. Aluminum 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 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

■ 5 olids. Percent (%) olids. Settleable 15. Solids. Suspended 32. Oil and Grease 33. Phenol 34. Phosphorus, Total as P 51. Copper 52. Iron 53. Lead 70. Disk Deliverables TCLP 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. 1IV254 57. Molybdenum 75. TCLP-BNA’S 58. Nickel SAcstetpans az NYC-WTC_000027443