Chain of custody record, Westchester County Department of Labs

NYC 9/11 Public Portal Document

UI ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road. Valhalla. New York 10595 (914)593-5575.^ NYS-ELAP No. 10108 Time/Date Set______________________ • I . M < Form A-70 (rev. 1/96) S’ ' , AL Sample Type (circle one): i. Potable 3. Non-Potable Treated Bottle #’8: 2. Non-Potable 4. Other Chain of Custody? yes no Time/Date Collaeted: Comments: Coliected ByVcA uxtX Agency Code:. PWS#:__J__ .Source ID:. .Type Descriptor. Collected From: Bill to: Location’s/lndivlduars Name s - Name/Comoanv Street_____ ;____________________________ Street___________ Citv/St/ZiD‘ ____________ Citv/St/Zip Identificatipn d Source ________ _ Phone#:, ^Fax#:. Collection Point All. Vo I CA, CH. Bl? Check#: Amounts.

ORGANIC POTABLE ANALYSES . ORGANIC NONPOTABLE/SOLID ANALYSES

: 1. Heterotrophic ; 1. Trihalorrielhanes (524) • ' 1. Purgeable Halocarbons (624/8260) 2. Purgeable Aromatics (624/8260) Count (homodialysls&ailcrthers) ,2. Coliform P/A (public supplies) 3. Coliform MPN (priy3»ell, raw. stp) ft Volatile Halocarbons (524) .^Volatile Aromatics (524) 4. Total Trihalomethane Potential (510) 3. Acrolein & Acrylonitrile (624) 4. Phthalates (606/8060) 4. Fecal Coliform (ail samples) 5. Microextractables (504) 5. Organochlorine Pesticides (608/8080) - 5. Microscopic 6. Pesticides (507) 6. PCB's (Arochlors) (608/8080) 6. Macroscopic 0 Pesticides/PCB screen (508) 7. Herbicides (SM-18/6640; 8151) 7. AP! 8. PCB as Decachlorobiphenyl (508A) 8. Other Pesticides (SM-18/6630) 4' 9. Petroleum Hydrocarbon Scan (310-13) 8. Other:________________ Herbicides (515) Pesticides (525) 10. Glycols in Water Refrigerated? yes no 11. Carbamate Pesticides (531) j 11. Acid Extractables (625/8270) 12. Glyphosate (547) I^Base Neutral Extractables (625/8270) Chlorinated?: .yes no “13. Diquat (549) ^^/GC/MS Unknown Scan 44. Chlorination Disinfection Byproducts (551) 14. Purgeable Halocarbons (DEF) 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/L ■17. Petroleum/Hydrocarbon Scan (310-13) 17. PCB's (Arochlors) (DEF)

pH, A*

----------------------------------------------- INORGANIC ANALYSES REQUESTED^ab#.. (circio tests) ! . .J 1. Color 2p. Acidity 39. Aluminum 59. Potassium * 2. Turbidity 2); Aflalinity. as CaCOa 40. Antimony 60. Selenium ’ 3. pH 22, Bromide 41. Arsenic 61. Silver ’ 4. Conductivity 23. Bromate/Chlorate/Chiorite 42. Barium 62. Sodium 5. Corrosivity (temp; ’C) 2<Ch!onde 43. Beryllium 63. Thallium 6. BOD (5 day) 26^ 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 CaCOa 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-volatiles 12. Total Organic Halides 31. Nitrogen. Total Kjeldahl as N SO. Cobalt 69. Pesticides/PCB’s 13. Solids, Percent (%) - 32. Oil and Grease 51. Copper 70. Disk Deliverables 14. Solids, Settleable 33. Phenol 52. Iron IStE 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-Herbicides 4 18. Solids. Total Volatile 37. Surfactants 56. Mercury 74. TCLP-Volatiles 19. Other:_______________ 38. IIV254 57. Molybdenum 75. TCLP-BNA's 58. Nickel

NYC-WTC_000070407