Chain of custody form, Westchester County Dept of Labs, Oct

NYC 9/11 Public Portal Document

( fat ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 MS uleciohostor county 0— (914)593-5575 NYS-ELAP No. 10108 Gne/Date Set:_____ _ 02ut 2017 6*7.77 390907$7/27 Form A-70 (rev. 1/96) Sample Type (circle one): 709 6 4/<Y 1. Potable • 3. Non-Potable Treated 801075s. 0163 2. Non-Potable 4. Other Chain of Custody? ves........ 00 Time/Date Collected: .. .................................- (60 Comments: — 3 PWS #: Type Descriptor: Collected By: V . ‘ " ■ .... Agency Code:. Source ID: Collected From: Mto: . Location’s/Individual’s Name. _ Name/Company. Street . - Street / City/SZip_ . Citv/St/Zio Identification of Source ..... bro* Phone#: Fax #: Collection Point. ___ 2/224 CA, CH, BI?_ Check#: Amounts.

BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLE/SOLID ANALYSES ... ............... Lab #_ (circle tests) (circle tests) 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. CoMorm 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 (606/8060) 4. Fecal Coliform (all samples) 5. Microextractables (504) 5. Organochlorine Pesticides (608/8080) 5, Microscopic 6. Pesticides (507) . 6. PCB’s (Arochlors) (608/8080) 6. Macroscopic 0 Pesticides/PCB screen (508) 7. Herbicides (SM-18/6640; 8151) . API 8. PCB as Decachlorobiphenyl (508A)' 8. Other Pesticides (SM-18/6630) Ceother 9. Herbicides (515) 0 Pesticides (525) 9: Petroleum Hydrocarbon Scan (310-13) 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) did Chlorinated'’: yes no 13. Diquat (549) 13) GC/MS Unknown Scan . 14. Chlorination Disinfection Byproducts (551) 14. Purgeable Halocarbons (DEF) Free Chlorine Res: ma/L . . o. -eey naidaceul Acius 15. Purgeable Aromatics (DEF) me 030 16. Other Pesticides (SM-18/6630) . 16. Pesticides (DEF) -—== Total . Chlorine Res: — - 17. Petroleum/Hydrocarbon Scan (310-13), , 17. PCB's (Arochlors) (DEF) jny *, --------------- ------ ■Td > v ---- / -- 7 ---- --------------------- - ------------------------------ - INORGANIC ANALYSES REQUESTED - - Lab#:.------------------------- nub ---- A

C (circle tests) 1. Color 20:Acidity ' 39. Aluminum w 59, Potassium 2. Turbidity 21. Wkalinity, as CaCO3 40. Antimony 60. Selenium 3- PH . 22. Br omide 41. Arsenic^ 61. Silver c mats

4. Conductivity 52,, 5. Corrosivity (temp:" °C) 23. Br•6mate/Chlorate/Chlorite 24. Chloride 42. Barium . 62. Sodium 43. Beryllium' — 63. Thallium 6. BOD (5 day) 25. Cyanide 44. Boron 64. Vanadium .. ty*

7 Soluble.BOD (5 day) 26. Fluoride • 45. Cadmium 65. Zinc 8. Carbonaceous BOD (5 day) 27. Hardness, Total as CaCOa 46. Calcium, as CaCOa CLP 9. Chemical Oxygen Demand 28. Nitrogen, Ammonia as N 47. Calcium, Ca*2 66. Metals/CN ws 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-volatiles -i

12. Total Organic Hal des 13. Solids, Percent (%) 31. Nitrogen, Total Kjeldahl as N 32. Oil and Grease 50. Cobalt 51. Copper . 69. Pesticides/PCB’s 70. Disk Deliverables C t Solids, Settleable 33/Phenol 52. Iron TCLP S Solids. Suspended 34. Phosphorus, Total as P 53. Lead 71. TCLP-Metals 16. Solids, Total 35. Phosphorus, Ortho as P 54. Magnesium 72. TCLP-Pesticides 17. Solids. Total Dissolved' 36. Sulfates - 55. Manganese 73. TCLP-Herbicides 18. Solids. Total Volatile 37 Surfactants 56. Mercury 74. TCLP-Volatiles 19. Other:_________________ 38. IIV254 . 57. Molybdenum 75. TCLP-BNA’s ■ 58. Nickel ----- . *** aa - - - NYC-WTC_000027893