Chain of custody record, Westchester County Department of Labs

NYC 9/11 Public Portal Document

w ■ ■■ ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM m WESTCHESTER COUNTY LABORATORIES ANO RESEARCH 8.0® 2 Dana Road, Valhalla, New York 10595 Utestebwtsf County (914)593-5575 NYS-ELAP No. 10108 Time/Date Set; Form A -70 (rev. 1/96) , - . f , rm , - ■ r Sample Type (circle one): 1.) Potable 3. Non-Potabie Treated Bottle #'s;„:____ ' r r ,< 2. Non-Potable 4. Other, Chain of Custody?yes no i ime/Date Coliscted:( r; ■ 'j !.' / Comments;: Collected Bv: ' ' . ■ ; Agency Code: PWS ..... ... .. .. .......... : „Source ID:Type Descriptor:. Illi CoHected From: Bill to; Location's/lndividual’s Name__ _________ __________ ; Name/Company____ j Street tT U? ■■ L C " . ;■ '____ _ Street City/St/2ip \.4 i ; ' H T , V U V i) " City/St/Zip J Identification of Source_______ Pi;one#: i Fax #; Collection Point mC | , Check#: Amounts

BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLE/SOLiD ANALYSES Lab#;_________________________ Lab ' (circle Sesis) (ci'cie losis; 1. Heterotrophic Plate 1. Trihalomethanes (524) 1. Purgeable Halocarbons (624/8260) : Count (hemodialysis & ail others) CaN Volatile Halocarbons (524) 2. Purgeabie Aromatics (624/8260) 2, Coilform P/A (public supplies) Volatile Aromatics (524) 3. Acrolein & Acrylonitrile (624) 3. Coliform MPN (priv well, raw, stp) 4. Total Trihalomethane Potential (510) 4. Phthalates (606/8060) III 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 Pesticides/PCB screen (508) 7. Herbicides (SM-18/6640: 8151) 8." PCB as Decachlorobipheny! (508A) 8. Other 8. Other Pesticides 8/6630) (SM~18/6630) Pesticides (SM~1 8. Other;: .^9.^. Herbicides (515) 9. Petroleum Hydrocarbon Scan (310-13) ■ Pesticides (525) 10. Glycols in Water i Refrioerated? Y8S„, __ no Xf Carbamate Pesticides (531) 11. Acid Extractables (625/8270)

■■0 12. Glyphosate (547) 13. Diquat (549) I^Base Neutral Extractables (625/8270) I^GC/MS Unknown Scan Chionnated'T ..yesj „.no I 14. Chlorination Disinfection Byproducts (551) 14. Purgeable Halocarbons (DEF) Free Chiorine Res;j •15. Haioacetic Acids (552) 15. Purgeable Arorr^atics (DEF) 16. Other Pesticides (SM-18Z6630) 16. Pesticides (DEF) Total Chiorine Res:: mg/L Bl 17. Petroleum/Hydrocarbon Scan (310-13) 17. PCB's (Arochlors) (DEF)

pH, ■

11 INORGANIC ANALYSES REQUESTED Aiab#: ' -'-t (nrclt- (GStsi y ......... . .... iiiiiiOiiiiO 1. 2. Coior Turbidity IIIJIIIBIBBIIII 20. Acidity : 2.1. Alkalinity, as CaCOs '22. Bromide 39. Aluminum Antimony 41*. Arsenic 59. Potassium 60. Selenium 61. Silver f'tr-' - 4. Conductivity ■.-23, Bromate/Chlorate/Chlorite 42. Barium 62. Sodium 5 Corrosivity (temp: '^.Chloride ^3. Beryllium 63. Thallium 6. BOD (5 day) 25. Cyanide 44. Boron 64. Vanadium ; T Soluble BOD (5 dayi 26. Fluoride 45. Cadmium 6hZ:cc________ CLP”"' ” ■ ■ 6 Carbonaceous BOD (5 day) 27. Hardness, Total as CaCO^ 46. Calcium, as CaCOa 9. Chemical Oxygen De.mand 28. Nitrogen, Ammonia as N 47. Calcium, Ca"^ . MelaHTCN 1/' ■ ■■: ••:e*vg.'!; '0 Niimj*-i. N-.-af--.a: \ -R:. C-i";v \;::o .ut.il 67. Volatiles , 1i ‘C.-.i’Cm uuc C::-;:?'. 3' . r.;-:: rvuit' .U. \ 4<» CL:;.-Ui:U!-, Hexavalent ........................ or.-. Semi-volatiles 1. T.t. 2’.N.*:.4m.T:.:.'K-:i.:i;..N -------- " G<-' Pesticides/PCB’s 13. Solids, Percent (%) ' 32. Oil a^d Grease 70 CisXHohvcmhhrs 33. Phenol letp

■ n-i 54. Magnesium 17. Solids, Total Dissolved 36. Sulfates ,• 55..Manganese

■0 ■ ■HUI 18. Solids. Total Volatile

i 37. Surfactants

III

NYC-WTC_000070247