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 Time/Date Set __________ Form A-70 (rev. 1/96) Sample Type (circle one): y Potable 3. Non-Potable Treated Bottle ff8:~ 2. Non-Potable 4. Other.______ Chain d Custody? yes .no TimeOateCollaeted:. ff- J'O f Comments: '■ Collected By:___ .Agency Cod:! PWS .Source ID:. .Type Descriptor:. Collected From: BllltoWV Narn^iUny_ Location’sZIndividuars Name. Street__________ _____ StreOli_ c City/St/ZiD 'ty/st/zip. Identification of Source _Fax Collection Point__ui£;_ZS I C^^H, Bl?. "SB MUatdu.US Check#:, Amounts, v'- BACTERIOLOGICALANALYSES; / VM I ORGANIC NONPpTABLE/SOLID ANALYSES

(drcte teste).. 1. Heterotrophic PlaWn^^^fe$.V* 9 lomethanes I® K ’ 1. Purg^i^aiocarbon8 (624/8260) Count (hemodialy^le^SraMrs) /^^ile i^Iocarbol 2. Purgeable Aromatics (624/8260) 2. Coliform P/A (public s£^® 3. Coliform MPN (priv we'il, rdw,- 8tp) ypj^'Volatile Aromaticsl Ir ^^Total Trihalomet^ ff Potential (510) aWrbfeiri&Acrylonitrile (624) 4, Phthalates (606/8060) - 4. Fecal Coliform (all samples) '- 5. Microextractable^i(504) 5, Organochlorine Pesticidos (608/8080) 5. Microscopic 6,, Pesticides (507)W- .6. PCB's (Arochlors) (608/8080) p 6. Macroscopic □ Pesficides/Pra^reen (508) ’7. Herbicides (SM-18/6640; 8151) 7. AP! 8. PCB as Decachiorobiphenyl (508A) . 8. Other Pesticidos (SM-18/6630) 8. Other: Herbicide’(515) 9. Petroleum Hydrocarbon Scan (310-13) > /TO Pesticides (525) 10. GJyc^ in Water , Refrigerated? yes____ no IT Carbamate Pesticides (531) 11. AcTd Kxtractables (625/82^0) ■ 12. Glyphosate (547) t^fiase Neutral Extractables (625/8270) Chlonnated?: .yes no 13. Diquat (549) ^Y f / ^(13jScA^SXInknown Scan 14. Chlorination Di^hfection Byproducts (551) 14. Purgeabie Halocarbons (DEF) Free Chlorine Res:. .ntg/L 15. Haloacetic Acids (552) 15. Purgeable Aromatics (DEF) 16. Other Pesticides (SM-18/6630) .1 16. Pesticides (DEF) ‘ ’7 Total Chlorine Res: .mg/L 17. Petroleum/Hydrocarbon Scan (310-13) 17. PC'^s (Arochlors) (DEF) /

pH i

INORGANIC ANALYSES REQUESTED - Lab#:. (circle tests) I 1. Color 20. Acidity 39.Alumi/fim / 59. Potassium 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 CaCOa CLP 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 Grease 51. Copper 70. Disk Deliverables 14. Solids, Settleable 33. Phenol 52. Iron TCLP 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-Pesticides 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