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): 1. Potable 3. Non Potable Treated Bottle #’s: C gTJ 2. 'otable corner________ Chain of Custody? yes no Time/Date Collected: > < " Comments:___ l. Collected By:Zr Agency Code: PWS#:_____ _ Source. ID: .Type Descriptor: Collected From: BUI to: Location's/lndividuars Name PVoVSK Name/Company Street_______________ __________________ ' , Street________ City/St/Zip City/St/Zlp__ Identification , Phone#: Fax#: Collection PrAijwte'■ ■ t'./I ca.ch:1i?4B2 Check#: Anraunt$.

Y ORGANIC NONPOTABLE/SOUDANA(.YSIS

(drctet^^ (circle t^)’ J V v 4— 1. Trihalomethan'es (524)

s 1. Heterotrophic Plate 1. Purgeable Halocarbons (624/8260) Count (hemqigsly^ K aB others) Volatile Halocarbons (524) 2. Purgeable Aromatics (624^260) 2. Coliform P/A (public supplies) Volatile Aromatics (524) 3. Acrolein & Acrylonitrile (624) 3. Coliform MPN (priv well, raw, stp) Total Trihalomethane Potential (510) 4. Phthalates (625/8270) 4. Fecal Colifbrm (aO samples) 5. Microextractabies (504) 5. Organochlorine Pesticides (608/8081) 5. Microscopic 6. Pesticides (507) 6. RGB's (Arochlors) (608/8081) 6. Macroscopic Pesticides/PCB screen (508) 7. Methoprene (616) 7. API *8. PCB as Decachlorobiphenyl (508A) 8. Herbicides (EPAI978/8151) 8. Other__________________ Herbicides (515) 9. Pesticides (SMI8/6630) Refrigerated? Chlorinated:? yes yes no no 4 Pesticides (525) Carbamate Pesticides (531) 12. Glyphosate (547) 10. Petroleum Hydrocarbon Scan (310-13) II.GIycois- 12. Acid Extractables (625/8270) 13. Base Neutral Extractables (625/8270) 13. Diquat (549) Free Chlorine Res:. mg/L 14. Chlorination Disinfection Byproducts (551) GC/MS Semivolatile Unknown Scan Total Chlorine Res: mg/L 15. Haloacetic Acids (552) T5. Purgeable Halocarbons (DEF) 16. Pesticides (SMI8/6630) 16. Purgeable Aromatics (DEF) pH 17. Petroleum^fydrocarbon Scan (310-13) 17. Pesticides/PCB’s (DEF) 18. Other_______________________ 18. Other:_______________ _ _______ ! INORGANIC ANALYSIS REQUESTED - LabA { t4-; (circle tests) 1. Color 20. Acidity 39. Aluminum 59. Potassiun) 2. Turbidity 21. Alkalinity, as CaCO3 40. Antimony 60. Selenium 3. pH 22. Bromide 41. Arsenic 61. Silver 4. Conductivity 23. Bromate/Chlorate/Chlorite 42. Barium 62. Sodium i 5. Corrosivity (temp:. .“C) 24. Chloride 43. Beryllium 63. Thallium i 6. BOD (5 day) 25. Cyanide 44. Boron 64. Vanadium 7. Soluble BOD (5 day) 26. Ruoride 45. Cadmium 65. Zinc 8. Carbonaceous BOD (5 day) 27. Hardness, Total as CaCOa 46. Calcium, as CaCOs We 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.Cobalt 69. Pesticides/PCB’s 13. Solids, Percent (%) 32. Oil an Grease 51. Copper 70. Disk Deliverabies 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-Pesticldes 17. Solids, Total Dissolved 36. Sulfates 55 Manganese 73.TCLP-Horbicides 18. Solids, Tomi Volatile 37. Surfactants 56. Mercury 57 MolybdaTum 74. TCLP-Volatiles 19. Other:________________ 38. UV254 75.TCLP-BNA'S 58. Nickel

NYC-WTC_000070442