Chain of custody record, Westchester County Labs, Oct 2001

NYC 9/11 Public Portal Document

ill ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH £ 2 Dana Road, Valhalla, New York 10595 Uestchester County (914) 593-5575 NYS-ELAPNo. 1010 le/Date Set:_________________________ Form A-70 (rev. 1/96) Sample Type(circle one): pQ843"Ho4,tfflE4b,LotC ( 1. Potable 2 3. Non-Potable Treated Bottle #s:Q8l2o, C 9 634, G 680842, C485 2..Non-Potable 4. Other__________ __ Chain of Custody? yes no P Time/Date Collected: 0755 * /r . / % , J A Comments:. y Collected By: /1, AJewMa Agency Code: PWS #:. .Source ID:_______ Type Descriptor:. Collected From: BUI to: •J Location’s/Individual’s Name N8 < L){ + Name/Company. Street I1' vn < /— 1 A Ve Street_______ City/St/Zip \ i - i ik -r U 1 40*4 City/St/Zip Identification of Source___________ _ ____ ___ ____ Phone#: —Fax #: 4/Collection Point D)e Cl 6 CA, CH/Bl? Check#: Amounts

BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLE/SOLID ANALYSES Lab#: ____________ Lab #:_________________________ (circle tests) (circle tests) 1. Heterotrophic Plate 1. Trihaiomethanes (524) 1. Purgeable Halocarbons (624/8260) Count (hemodialysis & all others) ) 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 6. PCB’s (Arochlors) (608/8080) 6. Macroscopic (. Pesticides/PCB screen (508) 7. Herbicides (SM-18/6640; 8151) «API . 8. PCB as Decachlorobiphenyl (508A) 8. Other Pesticides (SM-18/6630) (ther__ 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) 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)

pH

INORGANIC ANALYSES REQUESTED - Lab#:. (circle tests) J ( J 1. Coior 20. Acidity 39.Aluminum A ′ 59. Potassium . : 2. T urbidity 21. Alkalinity, as CaCO3 (40. Antimony J 60. Selenium f ' 3. pH 22. Bromide 41. Arsenic 61. Silver 4. Conductivity 23. Bromate/Chiorate/Chlorite 42. Barium 62. Sodium 5. Corrosivity (temp: °C) 24. Chloride (43. Beryllium <63. Thallium 6. BOD (5 day) 25. Cyanide 44. Boron (^./Vanadium 7. Soluble BOD (5 day) 26. Fluoride 45. Cadmium 65. Zinc___________ 8. Carbonaceous BOD (5 day) 27. Hardness, Total as CaCO3 46. Calcium, as CaCO3 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 ( Solids. Settleable 33. Phenol 52. Iron TCLP "S. 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 ; (9 Other: . ATs 38. UIV254 (57. Molybdenum 75. TCLP-BNA’s 58. Nickel

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