Chain of custody record, Westchester County Labs, Oct 2001

NYC 9/11 Public Portal Document

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM ester govcom WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 (914) 593-5575 get NYS-ELAP No. 10108 e/Date Set: C-V .. r C 4 Form A-70 (rev. 1/96) Sample Type (circle one): 3 q-asu."6t 0. 116+ A152 11., 1. Potable 3. Non Potable Treated Bottle #‘s: _ .0.12 ________________ “A%. 190. ECM > 2. Non Potable 4. Other ___ _______ ----- kat—: Chain of Custody?___yes___ no Time/Date Collected: _ oqi. Uk Comments: Collected By: + Po Xs 0 Agency Code: _ Source ID: .Type Descriptor Collected From: ‘ D. Bill to: Location’s/ndividual’s Name V " Name/Company Street: Street_______ City/St/ZIp___________________ _ _ Identification of Source * Dt* Phone#: Fax#: ‘ 30907 —-n Collection Point SY) CA,CH,BI?_ Check#: Amounts.

BACTERIOLOGICAL ANALYSIS ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLID ANALYSIS Lab#:____________________ (circle tests) 1. Heterotrophic Plate Lab#:______ _ (circle tests) £ 1. Trihalomethanes (524) tHo 1. Purgeable Halocarbons (624/8260) "l Count (hemodialysis & all others) 2. Coliform P/A (public supplies) 2.Volatile Halocarbons (524) 3. Volatile Aromatics (524) 2. Purgeable Aromatics (624/8260) 3. Acrolein & Acrylonitrile (624) S 3. Coliform MPN (privwell, raw, stp) -4. Total Trihalomethane Potential (510) 4. Phthalates (625/8270) 4. Fecal Coliform (all samples) 5. Microextractables (504) 5. Organochlorine Pesticides (608/8081) 5. Microscopic 6. Pesticides (507) 6. PCB’s (Arochlors) (608/8081) @croscopic ' 7/ Pesticides/PCB screen (508) 7. Methoprene (616) Wl 8. PCB as Decachlorobiphenyl (508A) 8. Herbicides (EPA1978/8151) 8. Other.__________________ Herbicides (515) . 9. Pesticides (SM18/6630) Refrigerated? yes no Pesticides (525) 10. Petroleum Hydrocarbon Scan (310-13) 11. Carbamate Pesticides (531) 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 mg/L 15. Haloacetic Acids (552) 43. Purgeable Halocarbons (DEF) Total Chlorine Res: 16. Pesticides (SM18/6630) 16. Purgeable Aromatics (DEF) pH 17. Petroleum/Hydrocarbon Scan (310-13) 17. Pesticides/PCB’s (DEF) . 18. Other________________ ;______ 18. Other ■ T INORGANIC ANALYSIS REQUESTED - Lab#: i a (circle tests) / i 1. Color 20. Acidity 39. Aluminum 59. Potassium 2. Turbidity 21. Alkalinity, as CaCOs 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: °C) 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 SO.Cobalt 69. Pesticides/PCB’s 18Solids, Percent (%) 32. Oil an Grease 51. Copper 70. Disk Deliverables CSolids, Settleable 33. Phenol 52. Iron 15. Solids, Suspended 34. Phosphorus Total as P 53.Lead TCLP 35. Phosphorus, Ortho as P 54 Magnesium 71 .TCLP-Metals 16. Solids, Total 72.TCLP-Pestlcldes 17. Solids, Total Dissolved 36. Sulfates 55 Manganese 56. Mercury 73.TCLP-Herblcides 18. Solids, Total Volatile 37. Surfactants 19. Other:________________ 38. UV254 57 Molybdenum 74. TCLP-Volatiles 58. Nickel 75.TCLP-BNA‘s 6.

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