Chain of custody record, Westchester County Department of Labs

NYC 9/11 Public Portal Document

J!L ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road. Valhalla. New York 10595 (914) 593-5575 NYiS-ELAP No. lbl08 Time/Date Set: _______________________ Form A-70(rev,1/96) Sample Type (circle one): c- 1 C% 1. Potable 3. Non-Potable Treated Bottleys: / 2. Non-Potable 4. Other_____________ • Chain of Custody? yes no Time/DateCollacted:, c < . Kt Comments: Collected By: .Agency Code: PWS#:^ SourceJD:. Collected From: Bill to: Location’s/lndividuars Name. Name/Company_ Street__________________ Street City/St/Zip_______________ Identification of Source Citv/StfZiD Phone#:_ • Fax#:, ZZS2----SHI' Collection Point • I CA.CH, Bl? Check#:! • - Amounts

BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES ; ; ORGANIC NONPQTABLE/SOLIO ANALYSES Lab#: ' Lab '‘‘i' (circle tests) 1. Heterotrophic Plate Trihalom^hanes (524) z 'try 1.. Purgeable Halocarboqs. (?24/^Wwfe Count (hemodialysis & all others) 'X Volatile Halocarbons (524) 2. Coliform P/A (public supplies) Volatile Aromatics (524) ’ X ? i AproleinFAcryi6nitrlfo(iM4) !sfe%;B'^'^ < 3. Coliform MPN (priv well. raw. stp) Total Trihalomethane Potential (510) . 4. Phthalates (606/8060) 4. Fecal Coliform (all samples) 5. Microextractables (504) 5. Organochlorine pesticides (608/8080) , 5. Microscopic Pesticides (507) 6. PCB's (Arochlors) (608/8080). ? 6. Macroscopic 0 Pesticides/PCB screen (508) 7. Herbicides (SM-18/6640; 8151) > . 7- APi * 8. PCB as Decachlorobiphenyl (508A) _ , 8. Other Pesticides (SM-18/6630)- Y L V 8. Oth0r;_________________ 9. Herbicides (515) 'ft Petrdeum Hydrocarbon Scan (310-13) ' Pesticides (525) lO. Giycols in Water 1 Y < Refrigerated? yes no 11. Carbamate Pesticides (531) . 11. Acid Extractables (625/8270) .., 12. Glyphosate (547) 12, Base Neutral Extractables (625/8270) , Chlonnated?: .yes no 13. Diquat (549) GC/MS,Unknpwn Scan Y ;; .;Y ' 14. Chlorination Disinfection Byproducts (551) 14. Purgeable Halocarbons (DEF) Free Chlonne Res:, ftig/L 15. Haloacetic Acids (552) 15. Purgeable Arorhatics (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)

pH TF/F INORGANIC ANALYSES REQUESTED - Lab#:. (circle tests) 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 CaCOa 46. Calcium, as CaCOs CLP 9. Chemical Oxygen Demand 28. Nitrogen. Ammonia as N 47. Calcium. Ca*’ 66. Metals/CN r* <«xSl 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-Pesticides 17. Solids, Total Dissolved 36. Sulfates , 55. Manganese 73. TCLP-Herbicidos 18. Solids. Total Volatile 37. Surfactants 56. Meroury 74. TCLP-Volatiles 19. Other:_________________ 38. IIV254 .57. Molybdenum 75. TCLP-BNA'S-* ■■ 58. Nickel

NYC-WTC_000070358