Chain of custody record, Westchester County Department of Labs

NYC 9/11 Public Portal Document

JL ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 (914) 593-5575 NYS-ELAP Nd: 10108 Time/Date Set _________________________________ Form A-70 (rev. 1/96) Sample Type (circle one): 43 Potable 3. Non-Potable Treated Bottle 2. Non-Polable 4. Other_________________________ • Chain of Custody? .yes no Time/Date Collected:_________ Comments:.___ CoBected By: Agency Code: PWS#:^___ .Source-ID:. .Type Descr^or;. Collected From: Bill to: Location’s/lndividuars Name Name/Conpany__ Street _______________________ Street__________ City/St/Zip________________________ City/St/Zip______ _ identification of Source Phone#:, Fax#:, Collection Point BoHK s» I CA. CH. Bl? Check#: Amounts

BACTERIOLOGICAL AN/^YSES ORGANIC POTABLE ANALYSES . .. Lab#:__L^2J2-2LL_-k-:;^' Lab #:____ {dreteteste) ' ' " -• • •" (cfcle I (/' . ■ Y< 1. Heterotrophic Plale . 1. Trihalomethanes (524) a’: , .; Purgeable Count (hemodialysis & aH others) Volatile Halocarbons (524) - Purgeable Ar6matlg8(62^^}<X<^^ 2. 2. Coliform P/A (public supplies) Volatile Aromatics (524) 3. Acrolein & Acrylohrtrile (624rY ,-' - ' Y t : ' 3. Coliform MPN (priv well, raw. stp) 4. Total Trihalomethane Potential (510) 4. Phthalates(606/8060) 4. Fecal Coliform (all samples) 5. Microextractables (504) 5. Organochlorine Pesttcides (608/8080) - - PCB’s (Arochlore) (SOS/BOMi) -

J 5. Microscopic Pesticides (507) 6. 6. Macroscopic Pesticides/PCB screen (508) 7. Herbicides (SM-1ft/6640;8l51)' ? ■ •■■.

7.AP! A PCB as Decachlorobiphenyl (508A) 8. Other PesticidosJSM-l 8/6*p^) Y 8. Other.__________________ 9.Herbicides (515) 9. Petroleum’ Hydii^mbOT i^^ (310-13) @ Pesticides (525) " 10. Glycols ini Water • Refrigerated? yes____ no rf. Carbamate Pesticides (531) 11. Acid Extractables (625/8270) vk: -12. Glyphosate (547) 12. Base Neutral ExtractableS (625/8270) Chlonnated?: yes_____ no 13. Diquat (549) 14. Chlorination Disinfection Byproducts (551) (JM GC/MS -Unknown Scan f < 14. Purgeable Halocarbons (DEF) . ’ r- Free Chlonne Res:, .mg/L 15. Haloacetic Acids (552) 15. Purgeable Aromatics (DEF) 16. Other Pesticides (SM-18/6630) 16. Pesticides (DEF) Total Chlorine Res:

£H.

— ——— INORGANIC —— ANALYSES mg/L

— a REQUESTED ! 557. Petroleum/Hydrocarbon Scan (310-13)

^ Lsb#: — —— ______________ 17. PCB’s (Arochlors) (DEF) I /

(eifde teste) ,’ 1. Color 26: ASIdity 39. Aluminum 59. Potassium 2. Turbidity 21; A^alinity. as CaCOa 40. Antimony 60. Selenium 3. pH 21^. Bromide 41. Arsenic 61. Silver 4. Conductivity , 23. Brbmate/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 BOO (5 day) 27. Hardness, Total as CaCOa 46. Calcium, as CaCOs 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 ISLE 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-Pesticldes 17. Solids, Total Dissolvod 36. Sulfates 55. Manganese 73. TCLP-Herbicldes 18. Solids. Total Volatile 37. Surfactants 56. Mercury 74. TCLP-VolatBes 19. Other:_____________ 38. UV254 57. Molybdenum 75. TCLP-BNA’e 58. Nickel

NYC-WTC_000070357