Chain of custody record, Westchester County Department of Labs

NYC 9/11 Public Portal Document

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10S9S (914) 593-5575 NYS-ELAP No. 10108 Time/Date^et_________ Form A-70 (rev. 1/96) (circle one): ( 1. Potable ) 3. Non-Potable Treated Bottle 2. Non-Potable 4. Other^^^a,^_____________ • Chain of Custody?, .yes .no Time/Date Collected: Comments: CollectedBv:'T>• I. /^AgencyCode:. PWS#:___ .Souree.lD:. .Type Descriptor Collected From: _/”’' Bill to: Location's/lndividual’s Name Namo/Company Street _____________________________ Street_______i. City/SVZip__________ :_______________________ City/St/Zip^______ Identification of Sourco__ Phone#:^ Collection Point •^>750 BBSS |CA.CH Bl?. Check»: ^jAnw^^ ' '

BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES / ORGANIC NONPOTABLE/SOLID ANALYSES Lab#:____________ ________ Ub*_____ (circle tests). (circletests) » 1. Heterotrophic Plate 1. Trihalomethanes (524) Volatile Halocarbons(524) 2. Pur^S^Arpt^ic^^l^^^OlS' Count (hemodialysis & all others) 2. Coliform P/A (public supplies) Volatile Aromatics (524) . r > > 3. Acr3ein & Acrytonitnle (624) -:’L ,. - 3. Coliform MPN (priv well, raw, stp) Total Trihalomethane Potential (5i6) • 4. Phthalates (606/8q60) ; Y ; ' 4. Fecal Coliform (all samples) 5. Microextractables (504) 5. Organochlorine Pesticidos (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) 7. API 8. PCB as Decachlorobiphenyl (508Af 8. Other Pesticides(SM-18/6630) ' 8. Other:___________________ ^Herbicides (515) 9. Petroleurh Hydrocarbon Scan (310-13) fl® Pesticides (525) . , . 10. Glycols in Water / ; Refrigerated? yes____ no 11. Carbamate Pesticides (531)^ ' 11. Acid Extractables (625/8270) ; 12. Glyphosate (547) 12. Base Neutral Extractables (625/8270) Chlorinated?: .yes no 13. Diquat (549) £^CA4SJJnknoWn Scan t- 14. Chlorination Disinfection Byproducts (551) 14. Purgeable Halocarbons (DEF) 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: .mg/L 17. Petroleum/Hydrocarbon Scan (310-13) 17. PCB's (Arochlors) (DEF)

pH

INORGANIC ANALYSES REQUESTED - Lab#:. (circle tests) 1. Color 20. Acidity 39. Aluminum 59. Potassium 2. T urbidity 21. Alkalinity, as CaCOa 40. Antimony 60. Selenium 3. pH 22. Bromide 41. Arsonic 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 CaCOa £LE 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 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 TCLP 15. Solids. Suspended 34. Phosphorus. Total as P 53. Lead 71. TCLP-Metals 16. Solids. Total 35. Phosphorus. Ortho as P 54. Magnesium ■^4 72. TCLP-Pesticides 17. Solids. Total Dissolved 36. Sulfates 55. Manganese 7XTCLP-Herbicid08 18. Solids. Total Volatile 37. Surfactants 56. Mercury 74. TCLP-Volatiles 19. Other: _____________ 38.1.IV254 57. Molybdenum 75. TCLP-BNA’s 58. Nickel

NYC-WTC_000070359