Chain of custody record, Westchester County Lab

NYC 9/11 Public Portal Document

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM

UL itlestchester County

@ge/Date Set: ______________ WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 (914) 593-5575 , - yen NYS-ELAP No. 10108 Form A-70 (rev. 1/96) j al.a ■ Sample Type (circle one): 1 . 2 *• / • . .

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(1. Potable > 3. Non-Potable Treated r Bottle #‘s: 2”Non-Potable 4. Other_________ Chain of Custody? yes no M Time/Date Collected: / 2- - t Comments: L Y Collected Bv: WAA Agency Code: _ _ Source ID: Type Descriptor:, Collected From: Bill to: Location’s/In dividual’s Name N C, 1 ( ) Name/Company .r Street ■ .4 P- L ;. _VV _ Street_________ City/St/Zip v i i r i/Ay 1 r s / 1 ' _ City/StZip Identification of Source. Phone#:________ Fax #: ***** + Collection Point CA, CH, BI? Chieck#: Amounts

BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLE/SOLID ANALYSES Lab#: ________________ Lab #:______ • . M x• 1 (circle tests) • ___ (circle tests) 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) (7. ■' Pesticides/PCB screen (508) -6. PCB’s (Arochlors) (608/8080) 6. Macroscopic 7] Herbicides (SM-18/6640; 8151) P API 8. PCB as Decachlorobiphenyi (508A) 8. Other Pesticides (SM-18/6630) _ 9.... Herbicides (515) ..9. Petroleum Hydrocarbon Scan (310-13) 10. Pesticides (525) 10. Glycols in Water Refrigerated? yes no 11. Carbamate Pesticides (531) 11. Acid Extractables (625/8270) 12. Glyphosate (547) 12, Base Neutral Extractables (625/8270) Chionnated?: yes no i o. Diquat 13. iquat (045) (549) (1 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)

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INORGANIC ANALYSES REQUESTED - Lab#:. (circle tests) ! /r 1. Color 20. Acidity 39, Aluminum ( .59. Potassium .... 2. T urbidity 3. pH 21. Alkalinity, as CaCOs 22. Bromide 40, Antimony 41. Arsenic .4 0207 60. Selenium 61. Silver - _ 4. Conductivity 5. Corrosivity (temp: °C) 23. Bromate/Chlorate/Chlorite 24. Chloride 42. Barium (43. Beryllium AV 62. Sodium (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 13. Solids, Percent (%) 32. Oil and Grease 51. Copper 70. Disk Deliverables B Solids, Settleable 33. Phenol 52. Iron TCLP • 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 UL Solids. Total Volatile 37. Surfactants 56. Mercury 74. TCLP-Volatiles i (57, Molybdenum 19Other n, T * 38. UV254 75. TCLP-BNA’s 58. Nickel

NYC-WTC_000027550