Chain of custody record, Westchester County Department of Labs

NYC 9/11 Public Portal Document

JL ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road. Valhalla, New York 10595 (914) 593-5575 NYS-ELAP No, 10{08 TimeZDate Set:_________ Form A-70 (rev, 1/96) Sample Type (circle one): Potable 3. Non-Potable Treated BottlefsCogg^ . * IC'dS

2. Non-Potable 4. Other________ _________ ___________ ' Chain of Custody? .yes .no Time/Date Collected: ^4. ~ Comments: Collected By: Agency Code: PWS#:___ .Source JD:. .Type Descriptor:. Collected From: Bill to: Location’s/lndividuars Name_ Name/Company Street_______ Street__________ City/St/Zip_______ __ City/St/Zip Identification of Source. Phone#:^ Fax Collection Point a I CA, CH. Bl? Check#: Amounts, ‘ /

BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLE/SOL1D^LYSES_ ■ Lab•? (circle tests), ; r.; j S'-', (a"*”®”’ ^ 0 f / 1. Heterotrophic Plate ' J. -TrihaloriS^hanes (524) 1. Purgeable Haiocarb^^6aO<» wM Count (hemodiai^is &afl others) Volatile Halocarbons (524) 2. 2. Coliform P/A^(public supplies)'' I Volatile Aronhatics (524) 3. Acrolein & Acrylcnhifl^ 3. Coliform MPN (priv well, raw, stp) 4. Total Trihalomethane Potential (510) 4. Phthalates (606/8060) Fecal Coliform (all samples) 5. Microextractables (504) 5. Organochlorine Pestfcides(608/8080)^^ 5. Microscopic Pesticides (507) '6. PCB’s (Arochlors) (60M0<|^^F: 6. Macroscopic .' Pesticides/PCB screen (508) 7. Herbicides (SM-18/664ft,8^jJ<Wa^«^’ 7.APi PCB as Decachlorobiphenyl (508A) 8. Other Pesticides (SM-18i^630)_;^. F V ,,ii 8. Other:__________ _______ a Herbicides (515) 9. Petroleum Hydrocarbon Scot t3,l b-i 3)-W 0. Pesticides (525) 10. Glycols in Water > A . —’ Refrigerated? ves no Carbamate Pesticides (531) 11. Acid Extractables (625/8270) .F 12. Glyphosate (547) /2t.Base Neutral Extractable8 (625/8270) Chlorinated?: ves no ' 13. Diquat (549) {jyGC/MS UnKhQwn Scan , <: <l 14. Chlorination Disinfection Byproducts (551) 14. Purgeable Haldbarbons (DEF) i» 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/Lv 17. Pet’roleum/Hydrocarbon Scan (310-13) 17. PCB’s (Arochlors) (DEF)

f-'. . ■, 'j ■ >' £H___ _ __________B INORGANIC ANALYSES REQUES^D^Lab#: (circle tests) f 1. Color 2. Turbidity Aldity 21. A^alin'ity, as CaCOs 39. Aluminum 40. Antimony 59. Potassium! 60. Selenium 5 »a 3. pH 22. ^omide 41. Arsenic 61. Silver p 4. Conductivity 23. Bjomate/Chlorate/Chlorite 42. Barium 62. Sodium s 5. Corrosivity (temp: .’C) 24. Chloride 43, Beryllium 63. Thallium i 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 CaCOs CLP _9. Chemical Oxygen Demand 28. Nitrogen, Ammonia as N 47. Calcium, Ca*’ 66. Metals/CN ''io. 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 laz IS. 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-Herbicictes. ' 18. Solids. Total Volatile 37. Surfactants 56. Mercury 74. TCLP-Volatiles 19. Other;_____________ 38. IIV254 57. Molybdenum 75. TCLP-BNA’S 58. Nickel

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