Chain of custody record, Westchester County Department of Labs

NYC 9/11 Public Portal Document

: ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM

HI Time/Date Set:_________ WESTCHI COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 (9.14)593-5575 NYS-ELAP No. 10108 Form A-70 (rev. 1/86) Sample Type (circle one): ; - . f’ Potabl^ 3. Non-Potable Treated Bottle ys: X . / ___ 2?T3on-Potable 4. Other__________________ 'Chain of Custody? _ ^es no TimeA5ato Collected:___________ 1 Comments:______ CoHected By: ^^ftVk^qAaencv Coder PWS#:_________ .Source ID:, .Type Descriptor:. Collected Front' Bill to: Locatlon’s/lndivlduars Name. Name/Company Street Street_________ City/St/^ City/St/Zip________ Identification of S<X4rce_______ Phone#:, Fax»:, Collection Point Y < ■ 1 I CA, CH, Bl?, Check#: Amounts. x.i, ORGANIC POTABLEANALYSES ORGANIC NONPOTABLE/SOLID ANALYSES

1. ^Trihalomelhanes(524) 1. Purgeable Halocarbais (624/821^ WM ' Count (homodiatysfe & all c«hers) Volatile Halocarbons (524) 2. Purgeable Aromatics (624/8260). - 2. Co!if6rm P/A (pubJic 8U^ies) • _'Volatne Aromatics (524) 3. Acrolein & Acrylonitrile (624) A* 3. Coliform MPN (priv well, raw. stp) ' 4. Total Trihalomefhane Potential (510) 4. Phthalates (606/8060) 4. Fecal Coiifbrm(ajl samples) 5. Microextractables (504) . 5. Organochlorine Pesticides (608/8080) Q 5. Microscr^icr & Pesticides (507) '6. PCB’s (Arochlors) (608/8080) . ,6.Macroscopic "r': © Pesfcides/PCB screen (508) . 7. Herbicides (SM-18/6840; 8151) ■ . .. 7. API : 8. PCB as DecachlordJiphenyl (508A) 8. Other Pesticides (SM-18«630) ' 8. Other:______ ■ ; Herbicides (515) 9. Petroleum Hydrocarbon Scan (310-13) Pesticides (525) 10. Glycols in Water - Refrigerated? yes ' _ no .j - .11; Carbamate Pesticides (531) 11. Acid Extractabies (625/8270) : 12. Glyphosate (547) 12. Base Neutral Extractabies (625/8270) } Chtonnated?: yes no : J 13. Diquat (549) ©GC/MS Unknown Scan 14. Chlorination Disinfection Byproducts (551) 14. Purgeable Halocarbons (DEF) Free Chlorine 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)

INORGANIC ANALYSES REQUI •4 (circle tests) 1. Color 2. Turbidity Alkalinity, as CaCOs ^39jA!uminum I 40.|Antimony Potassium ^Selenium 1 'silver 3. pH ;i2^; Bromide I 41.|Arsenic Uy 4. Conductivity .‘,■23. Bwmate/Chlorate/Chlorite I 42.fBarium Sodium 5. Corrosivity (temp: .’C) ,.:2<. Chloride MX Beryllium 'Thallium 6. BOD (5 day) Cyanide 44. Boron 64. Vanadium 7. Soluble BOD (5 day) ' 26. Fluoride *,..4 45. Cadmium tS^Zinc 8. Carbonaceous BOD (5 day) 27. Hardness, Totafas CaCOa 46. Calcium, as CaCOs fiLE 9. Chemical Oxygen Demand 28. Nitrogen. Ammonia as N 47. Calcium, Ca*’ 66. MetalsZCN '^lO. Dissolved Oxygen 29. Nitrogen, Nitrate as N ^XJhromium, Total 67. Volatiles 11. Total Organic Carbon 30. Nitrogen, Nitrite as N Chromium, Hexavalent 68. Semi-volatiles 12. Total Organic Halides 31. Nitrogen. Total Kjeldahl as N /SoSCobalt 69. Pesticides/PCB’s 13. Solids, Percent (%) 32. Oil and Grease (stlCopper 70. Disk Deliverables 14. Solids, Settleable 33. Phenol I S2.ilron ISLE 15. Solids. Suspended 34. Phosphorus. Total as P MaZLead 71. TCLP-Metals 16. Solids. Total 35. Phosphorus. Ortho as P 54 Magnesium 72. TCLP-Pesticides 17. Solids. Total Dissolved 36. Sulfates /S^Vanganese 73. TCLP-Herbicides 18. Solids. Tot^Volatile 37. Surfactants , 156. Mercury 74. TCLP-Volatiles Pther\ ' ■ - 38. IIV254 157. Molybdenum 75. TCLP-BNA's I^Jnicwi

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