Chain of custody record, Westchester County Labs, Oct 2001

NYC 9/11 Public Portal Document

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM . tchester K

■ MGPUCOl: WESTCHESTER COUNTY LABORATORIES AND RESEARCH'"

_a(-914593-5575 2 Dana Road, Valhalla, New York 10595

NYS-ELAP No. 10146 "ime/Date Set: Form A-70 (rev.1/980 C. S 90 f i K 6 k9, =m=r "//. 7 Sample Type (circle one): 6 -303 » sa s : 5 7, Cr * 4 7 , ' ; $.4 Bottle #‘s__________ 2____ ___ "1. Potable i: 'ion : ‘ojber /n ai ‘d 2. Non Potable 4. Other__ Chain of Custody?___ yes no Time/Date Collected: / / / Comments: / Collected By: _A.N AN Agency Code:__ PWS # _ Source ID:.......... .... -Type Descriptor:___ Collected From: . Bill to: 1 Location’s/Individual’s Name . _ / : AS A I' Name/Company Street. .... AL/.. —DA Street...... City/St/Zip _A_ / Identification of Source___ AWAY SU City/St/Zip Phone#:_____ ___ _____ ____ Fax#: Collection Point____ ( Am CA,CH, Bl? _ Check#:........ _.... _ Amount

BACTERIOLOGICAL ANALYSIS ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLID ANALYSIS Lab#: Lab#: -.... : ) / / —} 22 7 (circle tests) (circle tests) Z -7 / 22— 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 (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) f Macroscopic 2. Pesticides/PCB screen (508) 7i Methoprene (616) JAPI_ 8. PCB as Decachlorobiphenyl (508A) 8. Herbicides (EPA1978/8151) 8. Other:_____ _ ____ ___ _........... _ 9. Herbicides (515) 9. Pesticides (SM18/6630) 10) Pesticides (525) Refrigerated? _..... yes

Chlorinated:?.. -.... yes no

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

12. Acid Extractables (625/8270)

Free Chlorine Res: mg/L 13. Diquat (549) —0010pm 14. Chlorination Disinfection. Byproducts (551) 13. Base Neutral Extractables (625/8270) 3 c - : mivolati.* i lb wn Sian Total Chlorine Res: mg/L 15. Haloacetic Acids (552) : . : abi ■; I mobo (i >: 1) 16. Pesticides (SM18/6630) 16. Purgeable Aromatics (DEF) pH 17. Petroleum/Hydrocarbon Scan (310-13) 17. Pesticides/PCB’s (DEF) 18. Other: 18. Other:________________________ _____

INORNAiC ANA: vslS RFOULSTED -: t . (circle tests) I hoata 1. Color 20. Acidity 39. Aluminum 59. Potassium 2. Turbidity 21. Alkalinity, as CaCOs 40. Antimony 60. Selenium 3.pHan 22. (Bromide 41. Arsenic 61. Silver 4. Conductivity : lomon* l 24, Chloride H m 42. Barium 43. Beryllium 2162. Sodium MMp 5. Corrosivity (temp: °C) 63. Thallium 6. BOD (5 day) 25. Cyanide 44. Boron 64. Vanadium 26. Fluoride 45. Cadmium 7. Soluble BOD (5 day) 8. Carbonaceous BOD (5 day) 27. Hardness, Total as CaCO3 46. Calcium, as CaCOs CLP 65. Zinc

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 50. Cobalt 69. Pesticides/PCB’s 32. Oil an Grease 51.Copper 13. Solids, Percent (%) 14. Solids, Settleable 3 , Phenol 52.Iron ,0 : ).. i rs br .. TCLP ■ 5. Solids, Suspended 16. Solids, Total 34. Pi ’■■■;,)! hi for* ns i ■ 35. Pnoptons 6 M: :• 53.LeadV 54 Magnesium , ! li.l P-Mt il. .: BMdd 17. Solids, Total Dissolved 36. Sulfates ' 55 Manganese 73. TCLP-Herbicides 18. Solids, Total Volatile 37. Surfactants 56. Mercury 38. UV254 67 Molybdenum - 74. TCLP-Volatiles 19. Other:.____ 58.Nickel 75: TCLP-BNA's ■

NYC-WTC_000027701