Chain of custody record, Westchester County Department of Labs

NYC 9/11 Public Portal Document ..*K

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): c y, ^7/. a/, 1. Potable 3. Non-Potable Treated Bottle #’s: 2. Non-Potable 4. Other __________________ _ Chain of Custody? Yes .no ..ja*- TImeOate CaHactad: /^^^*^ _________ Comments:____ Collectod By; "TSuf_______ Agency Code:-------------- . PWS #:________ .Source ID;. .Type Descriptor:. Collected From: V Location's/lndividuars Name _ J Narne/Company Street______________________________________ ____ . ■Stre« City/St/Zip__2___________________________________ City/St/Zip__ Identification of Source _____ ____________ ;______ Phone#:. _Fax #:, Collection Point . ICA.CH. BI? Check#:_____ Amounts. . ’-S'' • - . ■■■?:;

BACTERIOLOGICAL ANALYSES - ORGANICNONPOTABLE/SOLID ANALYSES Lab#:____i^.r\ ■ ' . ' • ■■■' Y-. ■ Y. /■; .•

(circle testa) - 1. Heterotrophic Plate / Pf*’ 1. Piirgeable Halocarbons (624/8260) eJI Volatile Hal^^hs (524) 2. Purgeable Aromatics (624/8260) Count (hemodialysis & all others) 2. Coliform P/A (public sullies) ’ ‘ Volatile Aror^tics (524) ' ; Y 3. Acrolein & Acrylonitrile (624) 3. Coliform MPN (priv well. raw. stp) 4. Total Trihalomethane Potential (510) " 4. Phthalates (606/8060) 4. Fecal Coliform (all samples) 5.. Microextractables (504) - 5. Organochlorine Pesticides (608/8080) £/? 5. Microscopic Pesticides (507) 6. PCB's (Arochlors) (608/8080) • • 6. Macroscopic Pesticides/PCB screen (508) . 7. Herbicides (SM-18/6640; 8151) 7. API 8. PCB as Decachlorobiphenyl (508A) . 8. Other Pesticides (SM-18/6630) 8. Other:_________________ ^Herbicides (515) 9. Petroleum Hydrocarbdn Scan (310-13) ^Pesticides (525) 10. Glycols in Water Refrigerated? yes____ no 11. Carbamate Pesticides (531) 11. Acid Extractables (625/8270) 12. Glyphosate (547) I^Base Neutral Extractables (625/8270) Chionnated?: .yes no 13. Diquat (549) Q^C/MS -Unknowm Scan 14. 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

INORGANIC ANALYSES REQUESTED - Lab#:. (circle tests) 0^ O ..J 1. Color 20. Acidity 39. Aluminum 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 j 7. Soluble BOO (5 day) 26. Fluoride 45. Cadmium 65. Zinc 8. Carbonaceous BOO (5 day) 27. Hardness, Total as CaCOs 46. Calcium, as CaCOs £jLe 9. Chemical Oxygen Demand 28. Nitrogen, Ammonia as N 47. Calcium, Ca*’ 66. Motals/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 50. Cobalt 69. Pesticides/PCB’s 13. Solids, Percent (%) 32. Oil and Grease 51. Copper 70. Disk Deliverables 14. Solids. Settleabie 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-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. UV254 57. Molybdenum 75. TCLP-BNA’s 58. Nickel _ ■- A -J NYC-WTC_00007041 1