Chain of custody record, Westchester County Department of Labs

NYC 9/11 Public Portal Document

ex

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__________ g ___________ Form A-70 (rev. 1/96) Sample Type (circle one): i? Potable 3. Non-Potable Treated Bottle #’s: 2. Non-Potable 4. Other _________ Chain d Custj^? .yes .no Time/Date CoBected^ • ’ H V\| I Comments:.____ CollectedByjf^ SAoencvCode: PWS#;________ Source ID: .Type Descriptor:. CcII««iFrom: Bill to; Location’s/lndividuars Name _________ Name/Company Street___ Street_________ City/St/Zip____ City/St/Zip______ identificatkm of । Phone»:__ -Fax#:, Collection Point. O I CA, CH, Bl? Check#: Amounts. ' ■A i'’

BACTERIOLOGICALANALYSES ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLE/SOLID ANALYSES

1.H.I6wtpfl< < 1. ■ Trihatomethanes (524) .-i- 1. Purgeable Halocarbons (624/8260) «■.*» Count (hembdialysls&ill.others) Volatile Halocarbons (524) 2. Purgeable Aromatics (624/8260) 2. Coliform P/A (public supplies) Volatile Aromatics (524) 3. Acrolein & Acrylonitrile (624) 3. Coliform MPN (priv well, jaw, etp) 4. Total Trihalomethane Potential (510) 4. Phthalates (606/8060) 4. Fecel Coliform (all samples) 5. Microextractables (504) 5. Organochiorine Pesticides (608/8080) .. 5. Microscopic Pesticides (50^) 6. TCB's (Arochlors) (608/8080) -= 6. Macroscopic @ Pesticide8/P.CB^en(508) 7. Herbicides (SM-18/6640; 8151) 7. API 8. PCB as Decachlorobiphenyl (508A) 8. Other Pesticides (SM-18/6630) 8. Other:__l__________ J •i! Herbicides (515) 0. Pesticides (525) 9. Petroleum Hydrocarbon Scan (310-13) 10. Glycols in Water . >

Refrigerated?;____ yes____ no 'S 11. Carbamate Pesticides (531) 11. Acid Extractables (625/8270) 12. Glyphosate (547) U Base Neutral Extractables (625/8270) Chlorinated?: ves no '13. Diquat (549) Qa GC/MS Unknown Scan 14. Chlorination Disinfection Byproducts (551) 14. Purgeable Halocarbons (DEF) Free Chlonne Res;. .mgA. ' 15. Haloacetic Acids (552) 15. Purgeable Aromatics (DEF) 16. Other Pesticides (SM-18Z6630) 16. Pesticides (DEF) Total Chlorine Res: .mg/L *17. Petroleum/Hydrocarbon Scan (310-13) 17. PCB’s (Arochlors) (DEF) ✓

INORGANIC ANALYSES REQUESTED <Lab< (eifdo tests) 1. Color gq-A^Sdity 39. Aluminum 59. Potassium 2. Turbidity Agf. Alkalinity, as CaCOa 40. Antimony 60. Selenium 3. pH Bromide 41. Arsenic 61. Silver 4. Conductivity .23. Bromate/Chlorate/Chlorite 42. Barium 62. Sodium 5. Corrosivity (temp; ’C) .Mcbloride 43. Beryllium 63. Thallium 6. BOD (5 day) 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 £LE 9. Chemical Oxygen Demand 28. Nitrogen, Ammonia as N 47. Calcium, Ca*’ 66. MetalsZCN '' 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 Qrease 51. Copper 70. Disk Deliverables 14. Solids. Settleable 33. Phenol 52. Iron ISLE 15. Solids. Suspended 34. Phosphorus. Total as P S3. Lead 71. TCLP-Metals 16. Solids. Total 35. Phosphorus, Ortho as P 54. Magnesium 72. TCLP-Pesticidos 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 58. Nickel

NYC-WTC_000070408