Chain of custody record, Westchester County Department of Labs

NYC 9/11 Public Portal Document

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM

JL Time/Date Set:_________ WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 (914) 593-5575 _ N YS-ELAP 10108 Form A-70 (rev, 1/96) Sample Type (circle one): 1. Potable 3. Non-Potable Treated { B^lZ#’s:>^^ * 56 2. Non-Potable 4. Other_____________ _l>*4;f?aln of Custody? ves .no ' ■>

Time/Date Collected:^. Comments: Collected By: w* • Agency Code:. Source, ID: Type descriptor:.

Collected From: Bill to: Location’s/lndividuars Name. Name/Companv Street______________ Street • City/St/Zip__________ Citv/SVZip Identification of Source. Ad _Wione#d^?,=d=i= _Fax»:_ - I CA.CH.^1? CollectionPpirrt _ Check#:, Amount$_ f:. BACTERIOLOGICAL ANALYSES rORGANICWA^,M!ALYSES ORGANIC NONPpTABLE/SOUD ANALYSES Lab#:__________________ ; (circle tests) 1. Heterotrophic Plate Count (hemodialysis & all others) >e\Volatile Haiocarbons(524) ‘ 2,-- Purgeable Aromatics{624/8260) 7 2. Coliform P/A (public supplies) l^^Volatile Arorhafics (524) ;. & Acrylonltril©’(624) 3. Coliform MPN (priv well, raw. stp) 4. Total Trihalomethane Potential (510) A 4; 'Phthalates (606/8060)' ; / 4. Fecal Coliform (all samples) 5. f/icrooxtractables (504) \ "S.’; Organochlorine Pestigfd^, (608/8080) 5. Microscopic 6b Pesticides (507) PCB’s (Arochlors) (6(^(^) 6. Macroscopic Q Pesticides/PCB screen (508) .i7.?Horb»ides(SM-18/6§^^51) 7.45Pi' r PCB as Decachlorobiphonyl (508A) /"S, Other Pesticides (SM^lO^) 8,>^ber:___________________ _ ^Herbicides(515) ' 9. Petroleum Hydrocarbon bcan (310-13) ^Pesticides (525) > ■ 10. Glycols in Water “ Refrigerated? .yes no tT Carbamate Pesticides (531 j 11. Acid Extractables.4625/8270) : i rf: 12. Glyphosate (547) ^-Base Neutral Extractables (6^8270) .. Chlorinated?: .yes no 13. Diquat (549) H3^C/MS,Unknown Scan fcr 14. Chlorination Disinfection Byproducts (551) iT Purgeable Halocarbons (DEF)' W Free Chlorine Res:. .mg/L 15. Haloacetic Acids (552) 15. Purgeable Aromatics (DEF) 16. Other Pesticides (SM-18/6630) 16. Pesticides (DEF) Total Chlorine Res:

pH .mg/L 17. Petroleum/Hydrocarbon Scan (310-13) 17. PCB’s (Arochlors) (DEF) w pi-'

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: ’Cl:).,24. Chloride 43. Beryllium 63. Thallium 6. BOD (5 day) ^?5j3yanide 44. Boron 64. vanadium 7. Soluble BOD (5 day) 26. Fluoride 45. Cadmium 65. Zinc 4 8. Carbonaceous BOD (5 day)I 27. Hardness, Total as CaCOs 46. Calcium, as CaCOs £LE 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-Pesticides 17. Solids, Total Dissolved ' 36. Sulfates 55. Mangano’s 73. TCLP-Herbicides 18. Solids. Total Volatile 37. Surfactants 56. Morcur)®'<v. 74. TCLP-Volatiles 19. Other:_________________ 38. IIV254 57. Molybd||ljm 75. TCLP-BNA’S 58. Nickel Wfe--

NYC-WTC_000070362