Chain of custody record, Westchester County Labs, Nov 2001

NYC 9/11 Public Portal Document

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ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM

HL LUBsfchBftorCounty WESTCHESTER COUNTY LABORATORIES AND RESEARCH

Time/Date Set:_______________________________________ _ 2 Dana Road, Valhalla, New York 10595 (914) 593-5575 A"’ NYS-ELAP No. 10108 Form A-70 (rev. 1/96) Sample Type (circle one): 727, 7/J. ’■7,Y3r /■ .

1. Potable 3. Non-Potable Treated Bottle 2. Non-Potable 4. Other_______ ____________________ Chain of Custody? .y®s no Time/Date Collected: ^// Comments: Collected By: « A Agency Code: PWS #:____________ Source ID:. .Type Descriptor:. Collected From: . Bill to: Location's/lndividuars Name _________________ Name/Company Street_________________ _ ____________________________ Street______________ City/SVZio _______________________________ City/St/Zip__________ Identification of Source.________ _________________________ Phono#: Fax #: Collection Point *7 I CA, CH, Bl? Check#: Amounts.

BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLE/SOLID ANALYSES Lab#: (drcte tests) 1. Heterotrophic Plate Lab#:___________ ' (circle tests) 1. Trihalomethanes (524) 1. Purgeable Halocarbons (624/8260) a Count (hemodialysis & all others) J Volatile Halocarbons (524) 2. Purgeable Aromatics (624/8260) 2. Coliform P/A (public supplies) i Volatile Arornatics (524) 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 6. Pesticides (507) '6. PCB’s (Arochlors) (608/8080) 6. Macroscopic Pesticides/PCB screen (508) 7. Herbicides (SM-18/6640; 8151) 7. AP! K PCB as Decachlorobiphenyl (508A) 8. Other Pesticides (SM-18/6630) 8. Other:___________________ 9, Herbicides (515) 9. Petroleum Hydrocarbon Scan (310-13) Pesticides (525) 10. Glycols in Water Refrigerated? ^es no 11. Carbamate Pesticides (531) 11. Acid Extractables (625/8270) 12. Glyphosate (547) 12. Base Neutral Extractables (625/8270) Chlorinated?: ves ! no 13. Diquat (549) T^GC/MS Unknown Scan 14. Chlorination Disinfection Byproducts (551) T4T^^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: .mg/L 17. Petroleum/Hydrocarbon Scan (310-13) 17. PCB’s (Arochlors) (DEF)

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INORGANIC ANALYSES REQUESTED - Lab#:. (circle tests) Yr;/ I 1. Color 20. Acidity 39. Aluminum 59. Potassium 2. T urbidity 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 CaCOa 46. Calcium, as CaCOa CL£ 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-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 ISLE 15. Solids. Suspended 34. Phosphorus. Total as P 53. Load 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:_____________ 38.1.IV254 57. Molybdenum 75. TCLP-BNA’S 58. Nickel >.*_ i'!:, . Ji.’

NYC-WTC_000070570