Chain of custody record, Westchester County Department of Labs

NYC 9/11 Public Portal Document

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM :com WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, VaihaDa. New York 10595 (914) 593-5575 NYS-ELAP No. 10108 Time/Date Set: Form A-70 (rev.1/98)

(circle one): ■■ 3. Non Potable Treated Bottle #-8: 2. Non Potablo 4. Other _______________________ Chain of Custody? _ _ye8___ no Tlme/DateCollected: Y i A ' Comments: Collected By: Agency Code: PWS#:^_________ Source ID: Typo Descriptor Collected From: Bill to: Location’s/lndividual’s Name Name/Company Street____________ _ ______ Street__________ City/SVZip ; • ' CIty/St/Zip,______ Identification of Scarce Fax#: — Collection Point' - ——' I CA.CH, Bl? Checl^. ArrtountS^ : * ■ A h-k*

BACTERIOLOGICAL ANALYSIS" ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOUPANAS^i / 7 Lab#: ''i- Lab#: (circle tests) (cirde tests) 1. Heterotrophic Plate 1. Trihalomethanes (524) 1. Purgeabie Halocarbons (624/8^) ' Count (hemodialysis & all others) ^^Volatile Halocarbons (524) 2. Purgeable Aromatics (624/8280) 2. Coliform P/A (public supplies) ■3; Aromatics (524) 3. Acrolein & Acrylonitrile (624) 3. Coliform MPN (priv well, taw, stp) 4. Total Trihalomethane Potential (510) 4. Phthalates (625/8270) 4. Fecai Coliform (aO samples) 5. Microextractables (504) 5. Organochlorine Pesticides (608/8081) 5. Microscopic 6.. Pesticides (507) 6. PCB’s (Arochlors) (608^1) 6. Macroscopic /7.Pesticid^CB screen (508) 7. Methoprene (616) 7. API 8. PCB as Decachlorobiphenyl (508A) 8. Herbicides (EPA1978/8151) 8. Other__________________ 9. Herbicides (515) 9. Pesticides (SM18Z6630) (l^ Pesticides (525) 10. Petroleum Hydrocarbon Scan (310-13) TO Refrigerated? yes no Carbamate Pesticides (531) 11. Glycols zi Chlorinated:? yes no 12. Glyphosate (547) 12. Acid Extractables (625/8270) ’ 13. Diquat (549) 13. Base Neutral Extractables (625/8270) Free Chlorine Res:. mg/L 14. Chlorination Disinfection Byproducts (551) (I^GC/MS Semivolatile Unknown Scan Total Chlorine Res: mg/L 15. Haloacetic Acids (552) 15. Purgeable Halocarbons (DEF) _ 16. Pesticides (SM18/6630) 16. Purgeable Aromatics (DEF) pH 17. Petroleum/Hydrocarbon Scan (310-13) 17. Pestiddos/PCB’s (DEF) 18. Other_______________________ 18. Other________________ SS V INORGANIC ANALYSIS REQUESTED - Lab#: (circle tests) Utrk'U.kS £ 1. Color 20. Acidity 39. Aluminum 59. Potassium 2. Turbidity 21. Alkalinity, as CaCOa 40. Antimony 60. Selenium CT, 3. pH 22. Bromide 41. Arsenic 61. Silver 4. Conductivity 23. BromateZChlorate/Chlorite 42. Barium 62. Sodium 5. Corrosivity (temp: =C) 24. Chloride 43. Beryllium 63. Thallium a 6. BOD (5 day) 25. Cyanide 26. Fluoride 44. Boron 45. Cadmium 64. Vanadium 65. Zinc J 7. Soluble BOD (5 day) 8. Carbonaceous BOD (5 day) 27. Hardness, Total as CaCOs 46. Calcium, as CaCOs "51? 9. Chemical Oxygen Demand 28. Nitrogen, Ammonia as N 47. Calcium, Ca*® 66. Metals/CN 10. Dissolved Orfgen 29. Nitrogen, Nitrate as N 48. Chromium, Total 67. Volatiles 11. Total Organte Carbon 30. Nitrogen, Nitrite as N 49. Chromium, Hexavalent 68. Semi-violatiles 12. Total Organic Halides 31. Nitrogen, Total K|eldahi as NI SO.Cobalt 69.Pesticides/PCB’s 13. Solids, Percent (%) 32. Oil an Grease 51. Copper 70. Disk Deliverables 14. Solids. Settleable 33. Phenol 52. Iron 15. Solids, Suspended 34. Phosphorus Total as P 53.Lead icle 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-Horbicldos 18. Solids, Total Volatile 37. Surfactants 58. Mercury 74. TCLP-Voteflles 19. Other________________ 38. UV254 57 Molybdenum 75.TCLP-BNA’8 58. Nickel NYC-WTC_000070454