Chain of custody record, Westchester County Department of Labs

NYC 9/11 Public Portal Document

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIEsUnD RESEARCH ^nn I I 2 Dana Road. Valhalla, NewYoi|l0595 msSKoittJtorw (914) 593-5578‘ NYS-ELAP No. 10108 Time/DateSet: _______________________________ ___ VW '‘Xy Vt? j>PotaW« 3. Non-Potable Treared . Bottle #’s:----- .-------------------- 2. Noi^^^le 4. Other ___________________ Chain of Custo<^____________ Lyes no Comments: ' Agency Code: PWS #: W _SourcelD:. YType^scripton «|Kgeted From: Bill to: u^tion’s/lndividuars Name,___________________ Name^Jompah^ ^eet------------------- —--------------------------------------- Street. '■City/SVZip_______________________ __________ ciy/stgip^W-' Identification of Source . Fax#: 4 Collection PoinL I CA.CH, gp Y Y _ Check#:___ _ Amounts^ ■/ Wbw BACTERIOLOGICAL ANALYSES K^yWWWpp<ble«olidS^5^es Lab#:____________________ (drcie teste) =1. Heterotrophic Plate ' Count (hemodialysis & all others) '“•Volatile Halocartxrns (K4) ^>£.2.SPulifcdm«ic8 (624/8260) - ■2. Coliform P/A (public supplies) Volatile Aromati<M:([524) " .'.' 'ff’/: ; ' 3, Acroleirj:& Acrylonitrile (624) 3. Cggform MPN (priv well, raw. stp) 4. Total Trihalomethane Potential (510) s': 4. Fecal Coliform (all samples) 5. Microextractables (504) 5. Microscopic 6. Pesticides(507) ;6. Macroscopic Q Pesticides/PCB i^reen (508) ■ '7AP{_ 8. PCB as Decachlorobiphenyl (508A) < ‘ 8. Othor Pesticides (SM-18/6630) ,•8. Other:___________________ 9. Herbicides (515) . . /fo Y- • , ,9. Petroleum Hydrocarbon Scan,(310-13) J t&Pestk^es(525) . ■Refrigerated?____ yes_____ no 11. Carbamate Pesticides. (5^ ) 11.AcidExtractables{625/8270) / ' 12. Glyphosate (547) Y 12. Base Neutral Ext ractables (625/8270) Chlorinated?:yes no 13. Diquat (549) ’: ^GC/MS Unknown Scan . 14. Chlorination Disinfection Byproducts (551) 14. Purgeable Halocarbons (DEF) Free Chlonne Res:, (Ttg/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) ..

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INORGANIC ANALYSES REQUESTED - Lab#: (circle tests) 1. Color 20. Acidity 39. Aluminum 59. Potassium : 2. Turbidity 21. Alkalinity, as CaCOs 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. Cacfmium ----- 65. Zinc__________ 8. Carbonaceous BOD (5 day) 27. Hardness, Total as CaCOa 46. Calcium, as CaCOs* * 47. cAfcium, Ca*’ £LE 9. Chemical Oxygen Demand 28. Nitrogen, Ammonia as N 66. Metals/CN 10. Dissolved Oxygen 29. Nitrogen, Nitrate as N 67. Volatiles .11. T®&l Organic Carbon 30. Nitrogen. Nitrite as N 49. C^Hiurp, Hexavalent 68. SerrU-voIatiles »12. Total Organic Halides 31. Nitrogen, Total Kjeldahl as N 50. C^ A 69. Pesticides/PCB’s '13. Solids, Percent (%) 32. Oil and Grease 51.Cop^ 70. Disk Deliverables 14. Solids. Settleable 33. Phenol 52. Iron TCLP 15. Solids. Suspended 34. Phosphorus. Total as P S3. 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-Herbicides 1^. Solids. Total Volatile 37. Surfactants 56. Mercury 74. TCLP-Volatiles 19. Other:_________________ 38. UV254 57. Molybdenum 75. TCLP-BNA's 58. Nickel A NYC-WTC_000070360