Chain of custody record, Westchester County Lab, Oct 2001

NYC 9/11 Public Portal Document

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM ster WESTCHESTER COUNTY LABORATORIES AND RESEARCH vcom 2 Dana Road, Valhalla, New York 10595 (914) 593-5575 (/Date Set: NYS-ELAP No. 10108 Form A-70 (rev.1/96)

Sample Type (circle one): 1 - i,I174311e, 1-Potable 3. Non Potable Treated Bottle #-8: 17 3) Is.3 2,1535, 23/1827 2. Non Potable 4. Other___________ Chain of Custody? yes no Time/Date Collected: i 1 | ‘o 2 n V 9:/2 AM Comments: Collected By: .Aus Agency Code: _ Source ID: Type Descriptor Collected From: Bill to: Location’s/lnclivldual’s Name By Name/Company Street _ _________________ Street______ _ City/St/Zip _ __________________ _ Identification of Source Phone#: ______ ; Fax#: Collection Point by • __ _____ 1 CA,CH, Bl? _ Check#: Amounts. “BACTERIOLOGICAL -=====-========== ANALYSIS ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLID ANALYSIS Lab#:". ________________ Lab#:--------- ----- (circle tests) (circle tests) 4 CT ’ • 1. Heterotrophic Plate Trihalomethanes (524) 1. Purgeable Halocarbons (624/8260) Count (hemodialysis & all others) 2. Coliform P/A (public supplies) 3. Coliform MPN (priv well, raw, stp) 4. Fecal Coliform (all samples) G Volatile Halocarbons (524) Volatile Aromatics (524) 4. Total Trihalomethane Potential (510) 2. Purgeable Aromatics (624/8260) 3. Acrolein & Acrylonitrile (624) 4. Phthalates (625/8270) 5. Microextractables (504) 5. Organochlorine Pesticides (608/8081) 5. Microscopic 6. Pesticides (507) 6. PCB’s (Arochlors) (608/8081) 60croscopic ( Pesticides/PCB screen (508) 7. Methoprene (616) 7. 8. PCB as Decachlorobiphenyl (508A) 8. Herbicides (EPA1978/8151) 8. Other:___________________ 9. Herbicides (515) 9. Pesticides (SM18/6630) Refrigerated? yes no no) Pesticides (525) 11. Carbamate Pesticides (531) 10. Petroleum Hydrocarbon Scan (310-13) . 11. Glycols Chlorinated:? yes no 12. Glyphosate (547) 12. Acid Extractables (625/8270) 13. Diquat (549) 13. Base Neutral Extractables (625/8270) Free Chlorine Res:. mg/L 14. Chlorination Disinfection Byproducts (551) 14/GC/MS Semivolatile Unknown Scan Total Chlorine Res: mg/L 15. Haloacetic Acids (552) 15. Purgeable Halocarbons (DEF) 16. Pesticides (SM18/6630) 16. Purgeable Aromatics (DEF) pH - 17. Petroleum/Hydrocarbon Scan (310-13) 17. Pesticides/PCB’s (DEF) 18. Other._______________________ 18. Other__________________

INORGANIC ANALYSIS REQUESTED - Lab#: (circle tests) 1. Color 2. Turbidity 20. Acidity 21. Alkalinity, as CaCOs 39. Aluminum 40. Antimony noda 59. Potassium 60. Selenium 3. pH 22. Bromide 41. Arsenic 61. Silver 4. Conductivity 23. Bromate/Chlorate/Chlorite 42. Barium 62. Sodium 5. Corrosivity (temp: 9C) 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-violatiles 12. Total Organic Halides 31. Nitrogen, Total Kjeldahl as N 50.Cobalt 69. Pesticides/PCB's 18Solids, Percent (%) 32. Oil an Grease 51. Copper 70. Disk Deliverables Volids, 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 36. Sulfates 55 Manganese 72.TCLP-Pesticides 17. Solids, Total Dissolved 73.TCLP-Herbicides 18. Solids, Total Volatile 37. Surfactants 56. Mercury 38. UV254 57 Molyodenum 74. TCLP-Volatiles 19. Other:________________ 75.TCLP-BNAs 58. Nickel

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