Chain of custody record, Westchester County Lab

NYC 9/11 Public Portal Document

JL ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 (914) 593-5575 NYS-ELAP No. 10108 “/Date Set:______ Form A-70 (rev. 1/96) Sample Type (circle one): (751, ” +2 418 1. Potable 3. Non-Potable Treated Bottle #s .12415/2 &1 4 (772------ 2. Non-Potable 4. Other. Chain of Custody?yes no Time/Date Collected: 17 7,0 t Collected By: _ _________________ A <.*22 gency A. Code:____ Comments: PWS #:_______ Source ID: Type Descriptor:. Collected From: Bill to: Location's/Individual's Name Name/Company. Strpet___________________________ Street________ City/SVZip________________________ City/St/Zip• Identification of Source______________ Phone#: Fax #: Collection Point 6 v - 58 CA, CH, Bl? Check#: Amounts

BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLE/SOLID ANALYSES Lab#:_________ ___ ________ (circle tests) Lab#:---- — UL(. (circle tests) P J ' ■ 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 (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 (508A) 8. Other Pesticides (SM-18/6630) We. ‘s 9. Herbicides (515) (10 Pesticides (525) / r" 9. Petroleum Hydrocarbon Scan (310-13) •* 10. Glycols in Water Refrigerated? .no 11. Carbamate Pesticides (531) 11. Acid Extractables (625/8270) YeSa 12. Glyphosate (547) 12. Base Neutral Extractables (625/8270) Chionnated?: y«s .no 13. Diquat (549) (13./GC/MS Unknown "Scan 14. Chlorination Disinfection Byproducts (551) 14. Purgeable Halocarbons (DEF) Free Chionne 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#:. Y i ■ (circle tests) 1. Color 20. Acidity 39. Aluminum 59. Potassium 2. Turbidity 21. Alkalinity, as CaCO 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: 6. BOD (5 day) °C) 24. Chloride 25. Cyanide 43. Beryllium 44. Boron 63. Thallium 64. Vanadium 7. Soluble BOD (5 day) 26. Fluoride 45. Cadmium 65. Zinc__________ 8. Carbonaceous BOD (5 day) 27. Hardness, Total as CaCOa 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 13Solids, Percent (%) 32. Oil and Grease 51. Copper 70. Disk Deliverables 10lids, 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. Surf actants 56. Mercury 74. TCLP-Volatiles 19. Other: _____________ 38. UV254 57. Molybdenum 75. TCLP-BNA’s 58. Nickel •V - sasnim A

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