Chain of custody record, Westchester County Department of Labs

NYC 9/11 Public Portal Document

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I0 ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM $ WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 (914)593-5575 ** * •* NYS-LAP No. B) 8 ime/Date Set:_____ .} A 7 (fi-V

Sample Type (circle one A ■ 2 v363 . 4f. , , (Awo0a4 III 1 Potable J 3. Non-Potable Treated Bottle #'s:_______ —_________ 2; • Non-Potable 4. Other___ ____________ - Chain of Custody?_______ yes_____ no Time/Date Collected:. J- ? 1 t ____________. Comments________________________ / Collected By:? urr wD_________ Agency Code:_________ PWS #:________ Source ID: Type Descriptor: - ' : p. 0 Location’s/Individual’s Name 4*0 15 r____ -______ ____ Street____ Pt i ssP < lk / . Street City/SVZip )) ! s ■ s ___ City/StZip t. Identification of Source................... ...... ........... .................................. Phone#:,_____ __ Fax# Collection Point 1 I I f' ' ........ ......... CA, CH, Bl? ‘ Check#: Amounts

----==-===== ==--==- BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLE/SOLID ANALYSES Lab#- ' senA.Pmomoaiaammor*nmn II siillmnmm m ■■ rimiliiiin.... mimir"n ......... mruu..... I.—.,........ - Lab # . _ _ (circle tests) . (circle tests) 1. Heterotrophic Plate 1. Trihalomethanes (524) 1. Purgeable Halocarbons (624/8260) Count (hemodialysis & all others) (2.) Volatile Halocarbons (524) 9 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 Potentia1(510) 4. Phthalates (606/8060) 4. Fecal Coliform (all samples) 5. Microextractables (504) 5. Organochlorine Pesticides (608/8080) 6 n a 6. PCB’s (Arochlors) (608/8080) 1 5. Microscopic 6. Macroscopic 6 ( Pesticides (507) Pesticides/PCB screen (508) 57. . Herbicides (SM-18/6640; 8151) ( 7.APL 8. PCB as Decachlorobiphenyl (508A) J 8. Other Pesticides (SM-18/6630) , Other:_______ _________ _ 9 Herbicides (515) - 9. Petroleum Hydrocarbon Scan (310- 0 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) d 3)GC/MS Unknown Scan 14. Chlorination Disinfection Byproducts (551) 14. Purgeable Halocarbons (DEF) Free Chionne 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 -........ 3 / WONGANAYSSRoUTSID (circle tests) _ 1. Coror 20. Acidity ■::■ .•

39. Aluminum ■' b 59. Potassium . > : ' 2. Turbidity 21. Alkalinity, as CaCO3 (40: Antimony • 60. Selenium 3pH 22. Bromide 41. Arsenic, _ 61. Silver 4. Conductivity 23. Bromate/Chlorate/Chlorite 42.. Barjum: 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 CaCO3 46. Calcium, as CaCOa CLP 9. Chemical Oxygen Demand 28. Nitrogen, Ammonia as N 47. Calcium, Ca’? 6is. Mennt/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 6s. ■:.■> n vol es 12. Total Organic Halides 31. Nitrogen, Total Kjeldahl as N ( 50. Cobalt 6: i. Pstin-Ptl " 13. Solids, Percent (%) 32. Oil and Grease 51. Copper _70.Disk Deliverables >4. Solids, Settleable 33. Phenol 52. Iron TCLP........... 15. Solids, Suspended 16. Solids, Total 34. Phosphorus. Total as P 35. Phosphorus, Ortho as P 54. Magnesium 53. Lead e /1. !l Me-t 11:' 2 00 Pest ides 17. Solids, Total Dissolved 36. Sulfates 55. Manganese 73. TCLP-Herbicides 18. Sohds, Total Volatile 37. Surfactants 56. Mercury 74. re P’-yeliriles 19. Other: z e - ■■ 38.UV254 (57) Molybdenum Z5. I Cl.P NA’s 58. Nickel

NYC-WTC_000027865