Chain of custody record, Westchester County Department of Labs

NYC 9/11 Public Portal Document

UI Ula*tchM«Br County ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 H (914) 593-5575 NYS-ELAP No. 10108 Time/Date Set; A f Form A-70 (rev. 1/96) imple Type (circle one): 7757 3. Non-Potable Treated Bottle #’s:___^^__________________ .. • Potable J « s, ;■ . • 2. Non-Potable 4. Other f i _______________ Chain of Custody? yes yes no Time/Date Collected: _______________ Comments;__________________________ . ■ ' ' ■* K • Collected By:_ Ic .Agenc'y Code: ~ ■ PWS #:^__________ Source ID: ID:Type Descriptor: Collected From: * Bill to: O Y. -v , ., - Location’s/lndividual's Name v _________ ■ *'-■ '■ . Name/Company Street_____________ ________ ITU___________ ' / Street City/St/Zip____________________2__________ :_____ . Citv/St/Zip Identification of Source 5_______________Phone#:_ '‘ _____________________ ____ .Fax #:. Collection Point (D * . . ' ■;. 'rcA, CH, BI?jY‘^*'’’:f • _fCheck#: Anribunt$ ■.

BACTERIOLOGICAL ANALYSES^ Lab#:_______ (circle tests) . J <?.'>- ■ / •p. 1. Heterotrophic Plate '• / Count (hemodialysis & all others) 7 Purg^able Aromatics-(624/82^-.^ 2. Coliform P/A (public supplies) • VolatileV\romati^(524) Y 3.- Acrolein & Acrylonitrile (624) 3. Coliform MPN (priv well, raw, stp) . 4. Total Trihalomethane Potential (510)'' 'x,; .4. Phthalates (606/8060) ./f 4. Fecal Coliform (all samples) 5. Microextractabies (504) . ’. * 5.. Organochlorine Pesticides’ (608/8080) 5. Microscopic •• .Pesticides (507), - r- PCB's (Arochlors) (608/8080)/t.A • Yit 6. Macroscopic . . Pesticides/PCB screen (508)' M.^fe;i>Y^ ’7.. Herbicides (SM-18/6640; 8151) , 7. API 8. PCB as Decachlorobiphenyl (5p8A)’A^t: ’''fQ '.01*?®^ Pesticides (iSM-18/6630) 8. Other:________________ Hefbicides^‘(515).= ’, '? ■‘./■-"CTT/t:- 9 ' Petroleum Hydrocarbon'Scan (310-13) ^3 0. Pesticides.'(525)' J-^.' .; /-tO. Glycpte.’in Refrigerated? yes no .11. Carbarriate' Pesticides (531) •; V, Y ■ .11. Acid Extr'actables (625/6270) ? ‘ • . ■ ■‘S.i 12. Glyphosate (547)’-/• ' JJL Base Neutral Extractable's (62^8270) Chlorinated?:yes no 13. Diquat (549)'■'i,*’' ,-''•' Y' ■ Qs/GC/MS Unknown Scan' • ,' Y . 14. Chlorination Disinfection'Byp'roducts (551) lA Purgeable Halocarbons (DEF) Free Chlorine Res;. mg/L .,15. Haloacetic Acids (552) 15. Purgeable Aromatics (DEF) 167'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 ,• /

INORGANIC ANALYSES REQUESTED - Lab#: (circle tests) T 1. Color 20. Acidity 39. Aluminum 59. Potassium 2. Turbidity 21. Alkalinity, as CaCOa 40. Antimony 60. Selenium 3. pH 22. Bromide 41. Arsenic 61. Silver 4. Conductivity ' 23. Bromate/Chlorate/Chlorite 42. Barium 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 CaCOs 46. Calcium, as CaCOs CLP 9. Chemical Oxygen Demand 28. Nitrogen, Ammonia as N 47. Calciurn^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 ICLP 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 • v 74. TCLP-Volatiles \ 19. Other:_________________ 38. I.IV254 57.'Molybdenum , 75. TCLP-BNA's ~ 58. Nickel "

NYC-Wtc_0C)00702T4