Chain of custody record, Westchester County Labs, Oct 2001

NYC 9/11 Public Portal Document

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ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM K

1* III UlestchesterGniy WESTCHCSTT R COHN' Y L.ARONATORS AND RF Si ARCH 2 Dana Road, Valhalla, New York 10595 (914 593-5575 2 :! U

NYS-ELAP No. 10108 cme/Date Set'___ Form A-70 (rev. 1/96) “Sample Type (circle 1. Potable' one) 3. Non-Potable Treated a 1e,2Y45R%%2 5S, FP,053, Bottle #‘s: 7435 w-5556,712, 1 ”7tT

20 Non -Potable 4. Other • Chain of Custody?___ _yes_____ no Time/Date Collected:. /O- -o / Comments: ! Collected By:. MA/ , AAA Agency Code: PWS #:___ .Source ID:_... Type Descriptor: Collected From: 901/2900/119/ Bill to Location's/Individual's Name N 1( ASICQ „ Name/Company Street _LNee k.DKve _ Street; . ....... _.. .... _ City/St/Zip VALHAA AY /0585 _______ _ City/St/Zip Identification of Source_ ___________________ .... ........ .......... Phone#:_ Fax #: Collection Point CA, CH. BP.......... Check#: ... Amount?

BACTERIOLOGICAL ANALYSES ORGANIC PATA9s E ANB| YSFC : ANC NORPOIAELT/OL[ ANAI YS! S Lab#:____ _ _________ _ _... ... Lab *:__ — (circle tests) (circle tests) Akor 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. 14, Acrolein & Acrylonitrile (624) Phthalates (606/8060) ' . 3. Coliform MPN (priv well, raw, stp) 4. Total Trihalomethane Potential (510)

a.65.. 4. Fecal Coliform (all samples) 5. Microextractables (504) Organochlorine Pesticides (608/8080)'; ' 5. Microscopic 6. Pesticides (507) PCB's (Arochlors) (608/8080) (72 Pesticides/PCB screen (508) 57, Herbicides (SM-18/6640; 8151) 0 Z.AR 6. Macroscopic

tOtber__ ____ ___ _ __ 8. 9, PCB as Decachlorobiphenyl (508A) ; Herbicides (515) 18. Other Pesticides (SM-18/6630) . 9. Petroleum Hydrocarbon Scan (310-13). do Pesticides (525) ' 2 10. Glycols in Water Refrigerated?_____ yes_____ no 11. Carbamate Pesticides (531) ■ ' A i xhtat ibko (Bzu/p/o) {

Chionnated?:___ yes_____ no 1?. Glyphosate (547) 13. Diquat (549) 14. Chlorination Disinfection Byproducts (551) 3 * : r Neutnt f xta 't • * ■ . (t,"5.b, / GC/MS Unknown Scan 14. Purgeable Halocarbons (DEF) ■ Free Chiorine Res:. _ mg/L 15. Haloace tic 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) ee * bis ANAYHSRCQUESFI (circle tests) eeee : b mda LX 1. Color 20. Acidity 39. Aluminum 59. Potassium 2. Itbiaity 21. Alkalinity, as CaCOa (40 Antimony 60. Selenium 3 ph 22. Bromide 41. Arsenic'.;. 61. Silver / j 4. 5 Conductivity Corrosivity (temp: °C) 23. Bromate/Chlorate/Chlorite 24. Chloride 42.Banum (43)Beryllm 62. Sodium; (632 Thallium 6. BCD (5 day) 25. Cyanide 44. Boron (64. Vanadium,' 1 ) 7. Soluble BOD (5 day) 26. Fluoride 45, Cadmium 65. Zinc : ‘ 8. Carbonaceous BOD (5 day) 27. Hardness, Total as CaCO3 46. Calcium, as CaCOj CLP ! 9. Chemical Oxygen Demand । 10. Dissolved Oxygen :47. Calcium, Ca2 7 28. Nitrogen, Ammonia as N 29. Nitrogen, Nitrate as N 48. Chromium, Total n Mrt ..I: • "$ 67. Volatiles | 11. Total Organic Carbon 12. Total Organic Halides (50/Cobal 30. Nitrogen, Nitrite as N 31. Nitrogen, Total Kjeldahl as N 49. Chromium, Hexavalent 68. Semi-volatiles 69. Pesticides/PCB’s

te we 13. Solids, Percent (%) 32. Oil and Grease 33.Phenol1 53.Leadreney 52.Ion--) 51. Copper TCLPesonde 70. Disk Deliverables

71..TCLP-Metals 16. Solids, Total - Sulfates s 36. Surfactant 17. Solids, Total Dissolved " 34. Phosphorus. Total as P “54. Magnesium Peemi 55. Manganese d 35. Phosphorus, Ortho as P 72. TCLP-Pesticides 4 I Cl G i I 11 i s -37. 18. Solids. Total Volatile 19. Other nmniaad 38.UV254Pene -57) Molybdenum m 56. Mercury 74 .TCLP- Volatiles 75. TCLP-BNA’s . - ' 58. Nickel

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