Chain of custody record, Westchester County Department of Labs

NYC 9/11 Public Portal Document

UlalS^^lLty ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 (914)593-5575 - / IK NYS-ELAP No. 10108 Time/Date Set: ________________________ Form A-70 (rev. 1/96) Sample Type (circle one): f '■' V ' ■ /• 1. Potable. 3. Non-Potable Treated Bottle #’s:__l__ 7' •* 2. Non-Potable 4. Other. Chain of Custody? .yes no •' • f Time/Date Collected: ■ ■■ •■ - J ' ■7. ■-,'■‘■7,^/ Cornments: Collected By: ■ ' .■ / Agency Code: _ PWS #:________ Source ID; Type Descriptor;, Collected From: • X ' Bill to: Lpcation'^lndividual’s' Name_:#jL__j54;________ Nam'e/Company Street___^___itlil___-_______ Street'"* .City/SVZip________ ________________________ :__ City/St/Zip Identification of Source — ■ Phone#:, Fax Collection Point! _______ | CA, CH. Bl?. Check#; Amounts. t'-, •,

.XgACTERIOLOGICALANALYSEJ 5- ORGANIC POTABLE ANALYSES ; ORGANIC NONPOTABLE/SOLID ANALYSES

I, nBwrsjrwniC (a,5e lasts). 1./ Trihalbmethanes (524) ?- ' T" ‘ ’t” ‘I .VPurgeable Halocarbons (624/8260)’;W^^- -OB - Count^^modiatysis;& all others) 2. \VolaVi¥Halocarbon's\^ , " -I.'iT. 2.;>Purgeable Aromatics (624/8260)' 2. Coliforni P/A!(public'‘suppiie'sj Y. 3.' ’Volatile Aromatjcs (524) 3. Acrolein & Acrylonitrile (624) B 3. Coliform MPN (priv well, raw, stp) 4. Total Trihaiomethane Potential (510) • 4. Phthalates (606/8060) ■ " ' 4. Fecal Coliform (all samples) ; .5. Microextractabies (504) 5. Organochlorine Pesticides (608/8080) ' 5. Microscopic ■ JL Pesticides (507);; 6. PCB’s (Arochlors) (608/8080) 7- <" ' Yi/ 6. Macroscopic '-m J/ P’esticides/PCB screen (508) , 7. Herbicides (SM-18/6640; 8151)‘j; 8. PCB as Decachlprobiphenyl (508A) j; ■ 8. Other Pesticides (SM-18/6630) 7. API ..' rt . 8. Other;______ Ju. Herbicides (515) , 9. Petroleum Hydrocarbon Scan (310-13) Pesticides (525) w ‘ , ' l0. Glycols in Water ’ ij Refrigerated? yes' no Th Carbamate’Pesticides_(531) . - 11. Acid Extractables (625/8270) ./Vc 12. Glyphosate (547)' J.3< Base Neutral Extractables (625/8270) Chlorin,ated?; ves no ‘ ‘ ■13. Diquat (549) ' • QjJ GC/MS Unknown Scan 14. Chlorination Disinfection Byproducts (551) 14. Purgeable Halocarbons (DEF) ,, Free Chlorine Res;. ________.mg/L ' 15. Haloacetic Acids (552) 7 15. Purgeable Aromatics (DEF) 16. Other Pesticides (SM-18/6630) 16. Pesticides (DEF) Total Chlorine Res: ’ mq/L <• 17. Petroleum/Hydrocarbon Scan (310-13) 17. PCB's (Arochlors) (DEF)

pH r;

INORGANIC ANALYSES REQUESTED i^ab#; (circle tests) 1. Color 20. Aridity 39. Aluminurh 59. Potassium i .C: 2. Turbidity . 2-1. Alkalinity, as CaCOa 40. Antimony 60. Selenium ; 3. pH ■. 22. Bromide 41. Arsenic 61. Silver ; 4. Conductivity ■ 23. Brpmate/Chlorate/Chlorite 42. Barium 62. Sodium ■ 5. Corrosivity (temp; ’C) 24.Chloride 43. Beryllium 63. Thallium e; BOD (5 day) 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 CaCOa 46. Calcium, as CaCOa CLP 9. Chemical Oxygen Demand 28. Nitrogen, Ammonia as N 47. Calcium,-Ca*^ 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-volatiles 12. Total Organic Halides 31. Nitrogen, Total Kjeldahl as N 50. Cobalt 69. Pesticides/PCB's 13. Solids, Percent (%) 32. Oil and Grease 51. Copper 70. Disk Deliverables 14. Solids, Settleable 33. Phenol 52. Iron TCLP 15. 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 ■

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