Chain of custody record, Westchester County Department of Labs

NYC 9/11 Public Portal Document

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ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM

111 County WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 (914)593-5575 ' ii

NYS-ELAP No. 10108 Form A-70 (rev.1/96) Time/Date Set:(: Sample Type (circle one): 7-'. ; 7f ' -• ' 1. -Potable 3. Non-Potable Treated Bottle ___________ _ -Y______ L___.................. 2. Non-Potable 4. Other_____________ _ _____ : Chain of Custody? yes no Comments: Collected By:Agency Code: PWS #: Source ID; Type Descriptor: Collected From: .. . Bill to: 1 -'.V Location’s/lndividual’s Name/Company■

city/svzip C/: Identification of Source, Phone#: ___ ___ „Fax #:, Collection Point rcBBi~~Bi?z Check#: Amounts

BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLE/SOLiD ANALYSES Lab#: .......... ....................... Lab #;_____ ____________ __ __ (circle tests) (Circle leslsi 1. Heterotrophic Plate 1.., Trihalomethanes (524) 1. Purgeable Halocarbons (624/8260) • Count (hemodialysis & all others) /2.1 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, raw, stp) 4. Total Trihalomethane Potential (510) 4. Phthalates (606/8060) 4. Fecal Coliform (ail santples) 5. Microextrnctables (504) 5, Organochlorine Pesticides (608/8080) 5, Microscopic 6. Pesticides (507) 6, PCB's (Arochlors) (608/8080) 6. Macroscopic J Pesticides/PCB screen (508) 7. Herbicides (SM-18/6640; 8151) 7 AP' 8. PCB as Decachlorobiphenyl {508A) 8. Other Pesticides (SM-18/6630) 9. Herbicides (515) 9. Petroleum Hydrocarbon Scan (310-13) 0O^Pesticides (525) 10. Glycols in Water Vf. Carbamate Pesticides (531) 11. Acid Exfractables (625/8270) 12. Glyphosate (547) 12. Base Neutral Extractables (62S/8270) a,:o„naled^.....jes no ■■ 13. Diquat (549) 14. Chlorination Disinfection Byproducts (551) IJ^GC/MS Unknown Scan 14. Purgeable Halocarbons (DEF) Free Chlorine Res:mg/L 15. Haloacetic Acids (552) 15. Purgeable Aromatics (DEF) 16. Other Pesticides (SM-18/6630) 16. Pesticides (DEF) Total Chlorine Res:i mg/L 17. Petroleurr/Hydrocarbon Scan (310-13) 17. PCB's (Arochlors) (DEF)

pH

INORGANIC ANALYSES REQUESTED - Lab#:: (Ciroie Fia -izi 1. Color 20. Acidity 39. .Aluminum 59. Potassium 2. Tiii'bidiiy 21. Alkalinity, as CaCOj •40. Antimony 60. Selenium F iFi 22. Bromide 41. Arsenic 61. Silver 4. Conductivity 23. Bromate/Chiorate/Chlorite 42,. Barium ■62.tSodium 5. Corrosivity (temp:.„‘’C) 24. Chloride -,43, Beryllium ( 63.-Thallium 6. BOD (5 day) 25. Cyanide 44. Boron B \64y Vanadium 7 Soluble BOD (5 day) 26. Fiuoride 45. Cadmium 6'5. Zinc_____________ : 8. Carbonaceous BOD (5 day) 27. Hardness, Total as CaCO,-! 46, Caicatif. no C.ECt ? ■ CLP 9. Chemical Oxygen Demand 10. Dissolved Oxygen 28. Nitrogen, Ammonia as N 29. Nitrogen. Nitrate as N ' 47, Calcium, Ca”'' 48. Chromium, Total ■ 66. Metals/CN 67. Volatiles 11. Total Organic Carbon rc N-n.. N :-7-o< Y .,o g .« i -v Hexavalent 68, Semi-volatiles 69. Pesticides/PCB's 70. Disk Deliverables TCLP n.Tu ■ T9. Other:____ ,___ l____ L.................... _.. ...... ....... ..........i 8. Nickel H ______ NYC-WTC_000070549