Chain of custody record, Westchester County Department of Labs

NYC 9/11 Public Portal Document

ENVIRONMENTAL SERVIAS SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Ro^yalhalla, New York 10595 (914)593-5575 NYS-ELAP No. 10108 © Time/Date Set________ Form A-70 (rev. 1/96) Sample Type (circle one); 4069 Potable 3. Non-Potable Treated fMii.ffa.mHt.- HI- Io 44 2. Non-Potable 4. Other___________ Chain of Custody? .yes no Time/Date Collected: ■SV" Comments:____ Collected By: _____Agency Code: PWS #: .Source IO:. .Type Descriptor.. Collected Front: Bill to: Location’s/lndividuars Name_ % NameZConpany Street_______ _ ________ Street_______ City/St/Zip___________ City/St/Zip______ Ide.ntification of Source Phone#:. ._Fax#:. Collection Point. I CA, CH. Bl? Check#;- ■ ;^AmountO-^'^^g-/^^7^;-

BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES ORGANIC NONPOTJ

(dreiet^)\ 7 < 'V ’’-" 1. Purg9able HaI«:ar^ (622'8260) 1. Heterotrophic Plate 1. Trihalomethanes (524) ' Count {hemodialysi8 & all others) Volatile Halocarbons (524) 2. Purgeable AromaW624/8260) 2. Coliform P/A (public supplies) Volatile Aromatics (524) 3. Acrolein & Aci^oftO? (6^4) 3. Coliform MPN (priv well, raw, stp) MT Total Trihalomethane Potential (510) 4. Phthaiates (606/8b60) 4. Fecal Coliform (all samples) 5. Microextractablos (504) 5. Organochlorine peWl'des (608/8080) 5. Microscopic Pesticides (507) 6. ECB’s (Arochlor8) (608/8080) 6. Macroscopic Pesticides/PCB screen (508) 7. Herbicides (SM;i^6^: 8151) 7.AP! 8. PCB as Decachlorobiphenyl (508A) 8. Other Pesticide? (SM-18/6630) - / a,:; 8. Other:_______ _ ________ '9. Herbtoides (515) 9. Petroleum Hydrocarboh Scah^^(310-13) '■ .0. Pesticides (525) . 10. Glycols in Water -Y-' Y ; Refrigei yes____ no ‘11. Carbamate Pesticides (531) 11. Acid Extractable8 (625/8270) .12. Glyphosate (547) 12. Base Neutral Extraiclables (625/8270) Chlonnati yes no ; 13. Diquat (549) GC/MS-Unknown Scan Y’/ ^ ’ ' ; ,14. Chlorination Disinfection Byproducts (551) 14. Purgeable Hakxtarbons (DEH • --------------------------- .... .. !---------------------------------- ■

Free Chlonne Res:, .rng/L 15. Haloacatic 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) i

pH aBaBnso. /

INORGANIC ANALYSES REQUESTCD>ab#: (circle tests) ' 1. Color 2,tT/l|idity 39. Aluminum 59. Potassium 2. Turbidity . 2^. ABcalinity, as CaCOs 40. Antimony 60. Selenium 3. pH % ^mide 41. Arsenic 61. Silver 4. Conductivity ' Brpmate/Chlorate/Chlorite 42. Barium 62. Sodium 5. Corrosivity (temp; .’C) Chloride 43. Beryllium 63. Thallium 6. BOD (5 day) 2k Cyanide 44. Boron 64. Vanadium 7. Soluble BOO (5 day) 26. Fluoride 45. Cadmium 65. Zinc__________ 8. Carbonaceous BOD (5 day) 27. Hardness, Total as CaCOs 46. Calcium, as CaCOs CUE 9. .. Chemical Oxygen Demand 28. Nitrogen. Ammonia as N 47. Calcium, Ca*’ 66. MetalsZCN ' 10. Dissolved Oxygen 29. Nitrogen, Nitrate as N 48. Chromium, Total 1 67. Volatiles 11. Total Organic Carbon; 30. Nitrogen, Nitrite as N 49. Chromium, Hexavalent 68. Semi-volatile's 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. Settleabie 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-Pesticldos 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. liV254 57. Molybdenum 75. TCLP-BNA’s 58. Nickel

NYC-WTC_000070356