Chain of custody record, Westchester County Labs, Oct 2001

NYC 9/11 Public Portal Document

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM otor WESTCHESTER COUNTY LABORATORIES AND RESEARCH

aonnnn1a(914) 593-5575_ 2 Dana Road, Valhalla, New York 10595

Time/Date Set: aFormA-70(rev.1/96)— NYS-ELAP No. 10108

Sample Type (circle one): Q99ol.Q9e,6489B.kn9,k60 Potable > 3. Non Potable Treated ■ Bottle #‘s: Cl2EQsLES6Q,.LB 2.Non Potable 4. Other__ ■ Chain of Custody?yes___ no * F- o 22 Time/Date Collected:__ / 4 i O.Q - O 1 Comments: J Collected By:—W6C I _ Agency Code:.... PWS #: ___ Source ID: _..._.. ..... Type Descriptor: _ Collected From: Bill to: . E___ Location's/Individual's Name___ NYCI Name/Company _ ■ i

Street_ Ct West LAC DAVE Street..... ............... City/St/Zip " 4 ‘ 1 ALA A 22 V _G City/SVZip.. -. — Identification of Source............... ......... . _____ Phone#:_____ Fax#: Collection Point...._CQ_Cn_____ CA,CH, BI?__ ____ _ ____ Check#: Amounts..

BASTERLOCPi ANAS YST' 7GANIC CAFE ANAI r58 QRGAC NONPOTAIE fSCl ID ANALYSIS Lab#:_____ _ _________________ __ Lab#:_ ____ ___ __ ..1.... (circle tests) (circle tests) rg 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, sip) ■ 4. Total Trihalomethane Potential (510) 4. Phthalates (625/8270) 4. Fecal Coliform (all samples) 5. Microextractables (504) 5. Organochlorine Pesticides (608/8081) . 15.Microscopic s Y Macroscopic —011 6. Pesticides (507) 7 z) Pesticides/PCB screen (508) : ) Ps(Aimo.. (i 10011 7. Methoprene (616) (___________............ 8. PCB as Decachlorobiphenyl (508A) • 8. Herbicides (EPAI 978/8151) 9 Herbicides (515) 9. Pesticides (SMI 8/6630) io) Pesticides (525) Refrigerated?____ yes _... . no

Chlorinated:? yes___ no 11. Carbamate Pesticides (531) 12. Glyphosate (547) 11.Glvcols 10. Petroleum Hydrocarbon Scan (310-13)

12. Acid Extractables (625/8270) 13. Diquat (549) 13. Base Neutral Extractables (625/8270) Free Chlorine Res:_. :.ir ■ 14. Chlorination Disinfection Byproducts (551) d4/GC/MS Semivolatile Unknown Scan

Total Chlorine Res: ___ mg/L 15. Haloacetic Acids (552) thi r | do dl n (i i l ) 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 - (circle tests) (lWrk 1, Color a 20. Acidity 39. Aluminum 40. Antimony 59. Potassium J 2, Turbidity 21. Alkalinity, as CaCO3 60. Selenium ) 3.pH 22. Bromide 41. Arsenic 42.Barium 61. Silver 1 . 4. Conductivity 23. Bromate/Chlorate/Chlorite 62. Sodium / 24. Chloride . 43.Beryllium 5. Corrosivity (temp: _____ °C) (63.Thallium ■ ’ ’ 1 .6. BOD (5 day) 25. Cyanide 44. Boron (64.anadium • i 7. Soluble BOD (5 day) 26. Fluoride 45. Cadmium 65. Zinc :. i 8. Carbonaceous BOD (5 day) 9. Chemical Oxygen Demand 27. Hardness, Total as CaCO3 28. Nitrogen, Ammonia as N 46. Calcium, as CaCO3 47.Calcium, Ca42 CLP_ 66. Metals/CN I 10. Dissolved Oxygen 29. Nitrogen, Nitrate as N 48. Chromium, Total yolle 11. Total Organic Carbon an Nilteir : Mthgs - N 4. a". I I ./ . 68. Semi-violatiles 31. Nitrogen, Total Kjeldahl as N (50.Cobalt 12; Total Organic Halides i t a Po ii-: rCl 13. Solids, Percent (%) 4 Solids, Settleable 33, Phenol t 52.Iron 32. Oil an Grease

53.Leada 51.Copper 70. Disk Deliverables TCLP_ 5554Maqnesium !I flv %: . Jo 34. Phosphorus Total as P 71 TCLP-Metals

17. Solids, Total Dissolved 3 Manganese 35. Phosphorus, Ortho as P 36. Sulfates 72. TCLP-Pesticides

(19.thersaerul if; Npa * . 1tal . a ... 37.Surfactants---AI- 38.UV254nan 67 56 Mercury Mol y ha - eeeg bdenum 73. TCLP-Herbicides 74. TCLP-Volatiles 58. Nickel a /5 IGINNAs

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