Chain of custody record, Westchester County Department of Labs

NYC 9/11 Public Portal Document

m ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH

Time/DateSet_____________________________________ Sample Type (circle one): 2 Dana Road, Valhalla, New York 10595 (914) 593-5575 NYS-ELAP No. ioi'is Form A-70 (rev. 1/96)

Potable 3. Non-Potable Tnatad Bottle #*8:. -to;:), 2. Non-Potable 4. Other._________________________ ' Chain of Custody? .yes ___no Time/Date Collected: 0^ :0 3 - Comments: Collected By:. Agency Code: PWS#:_________ .Source ID:. .Type Descriptor:^, Collected From: Bill to: Location’s/ln^^idual’s Name_ Name/Company.^ Streot__L^__:_________ Stroet________ City/SVZip____^________ City/St/Zip______ Identification of Source______ Phone#: Fax#: Collection Point A - I CA.CH. Bl?. ____ Check#:____ _ Amount$L ' '

ORGANIC NONPOTABLE/SOUD

1. Heterofrophic Piate ■ A. Trihalomethanes (524) I^^Volafile Halocarbons (524) I 1. Purgeable Halocarbons Count (hemodlaly8is & all others) 2. Purgeable Aromatics 2, Coliform P/A (public supplies) Volatile Arornatics (524) 3. Acrolein & Acrylonitrile (624) ’ -pXr ■ •-; 3. Coliform MPN.(priv well, raw. stp) * A Total Trihalomethane Potential (510) 4. Phthalates(606/8060) 4. Fecal Coliform (all samples) 5. Microextractabies (504) .5. Organochlorine Pesticides (608/8080) ; 5. Microscopic . Pesticides (507) 6. PCB's (Arochlors) (608/8080) 6. Macroscopic : '/ Pesticides/PCB screen (508) 7. Herbicides (SM-18/6640; 8151) ZAP! 8. PCB as Decachlorobiphenyl (508A) 8. Other Pesticides (SM-18/6630) 8. Otber: '. , ^Herbicides (515) 9. Petroleum Hydrocarbon Scan (310-13) @ 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) Chlonnated?: yes no 13. Diquat (549) ©GC/MS Unknown Scan / ■

14. Chlorination Disinfection Byproducts (551) 14. Purgeable Halocarbons (DEF) 15. Purgeable Aromatics (DEF) ■■■ Cv' Free Chlorine Res:. mg/L 15. Haloacetic Acids (552) 16. Other Pesticides (SM-18/6630) 16. Pesticides (DEF) Total Chlorine Ros: mg/L^ ; • 17. Petroleum/Hydrocarbon Scan (310-13) 17. PCB’s (Arochlors) (DEF)

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INORGANIC ANALYSES REQUESTED ^Lab#:. (circle tests) ’,’2^ 1. Color 39. Aluminum 59. Potassium 2. Turbidity 21, Alkalinity, as CaCOa 40. Antimony 60. Selenium 3. pH ,2£ Bromide 41. Arsenic 61. Silver i 4. Conductivity Bprnate/Chlorate/Chlorito 42. Barium 62. Sodium 1 *< cs 5. Corrosivity (temp: .’C) Chloride 43. Beryllium 63. Thallium L », r 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 CaCOs 46. Calcium, as CaCOa £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-Pestfcides 17. Solids, Total Dissolved 36. Sulfates 55. Manganese 73. TCLP-Herbicides 18. Solids. Total Volatile 37. Surfactants 56. Mercury 74. TCLP-Volatiles 19. Other:________ :_________ 38. IIV254 57. Molybdenum 75. TCLP-BNA's '.V»e 58. Nickel

NYC-WTC_000070393