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 10595 (914) 593-5575 NYS-ELAP No. 10108 Tlme/Date Set: Form A-70 (rBV.1/98)

Sampiejype (circle one): 3. Non Potable Tmated Bottle #’s: 3^*^. _______ 2. Non Potable 4. Other_________________________ _ Chain of Custody? yes no Tlme/DateCollectod: _ Comments: Collected By: Agency Code: _ PWS#:_______ Source ID: Type Descriptor Collected From: Bill to: Location’s/indivldual’s Name Name/Company Street____________________ Street________ City/St/Zip _ City/St/ZIp._____ Identification of Source _ Phone#; ____ Fax#; Collection Point "I - I CACK Bi^'SZI Check#: Amounts _____ y ■

BACTERIOLOQICALANALYSIS ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOUDANXLY^S Lab#; (circle tests) . 1. Heterotrophic Plate Trihaiometharies (524) 1. Purgeable Halocarbons (624/8260)^ Count (hemodialysis & all others) Volatile Halocarbons (524) 2; Purgeable Aromatics (624/8260) ' 2. Coliform P/A (public supplies) s^Volatile Aromatics (524) 3. Acrolein & Acrylonitrile (624) 3. Coliform MPN (priv well, raw, stp) 4. Total Trihalomethane Potential (510) 4. Phthalates (625/8270) C.’ 4. Fecal Coliform (all samples) 5. Microextractables (504) 5. Organochlorine Pesticides (608/8081). 5. Microscopic 6. Pesticides (507) 6. PCB’s (Arochlors) (608/8081) 6. Macroscopic ^Pesticldes/PCB screen (508) 7. Methoprene (616) ;> 7. API 8; PCB as Decachlorobiphenyl (508A) 8. Herbicides (EPAI978/8151) 8. Other__________ ________ 8. Herbicides (515) 9. Pesticides (SMI8/8630) Refrigerated?yes no ^Pesticides (525) 10. Petroleum Hydrocarbon Scan (Slb-IS) TT. Carbamate Pesticides (531) 11. Glycols Chlorinated^lTl yes no 12. Glyphosate (547) 12. Add Extractables (625/8270) 13. Diquat (549) Base Neutral Extractables (625/8270) Free Chlorine Res: mg/L 14. Chlorination Disinfection Byproducts (551) fu^C/MS Semivolatile Unknown Scan mg/L 15. Haloacetic Acids (552) lS? Purgeable Halocarbons (DEF) Total Chlorine Res: 16. Pesticides (SMI8/6830) 16. Purgeabie Aromatics (DEF) pH 17. Petroleum/Hydrocarbon Scan (310-13) 17. Pestlcides/PCB’s (DEF) 18. Other:_______________________ 18. Other____________ i -7.

INORGANIC ANALYSIS REQUESTED - Lab#; (circle tests) 1. Color 20. /teidity 39. Aluminum 59. Potas^um 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. 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 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-violatiles 12. Total Organic Halides 31. Nitrogen, Total Kjeldahl as N 50.Cobait 69.Pesticides/PCB’s 13. Solids, Percent (%) 32. Oil an Grease 51. Copper 70. Disk Deliverables 14. Solids. Settleable 33. Phenol 52. Iron 34. Phosphorus Total as P 53.Lead ICLE 15. Solids, Suspended 71 TCLP-Metals 16. Solids, Total 35. Phosphonjs, Ortho as P 54 Magnesium 72.TCLP-Pesticides 17. Solids, Total Dissolved 36. Sulfates 55 Manganese 56. Mercury 73.TCLP-Herbicides 18. Solids, Total Volatile 37. Surfactants 57 MolybdOTum 74. TCLP-Volatiles 19. Other______ ;_________ 38. UV2S4 75.TCLP-BNA’S 58. Nickel

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