Chain of custody record, Westchester County Labs, Nov 2001

NYC 9/11 Public Portal Document

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM

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Time/Date Set:_________ WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 (914) 593-5575 NYS-ELAP No. 10108 Form A-70 (rev. 1/96) Sample Type (circle one): 1. Potable 3. Non-Potable Treated Bottle __________ 2. Non-Potable 4. Other_____________ Chain of Custody?yes ' no Time/Date Collected:. / J Comments; Collected By: X .Agency Codo:_ PWS #:_______ Source ID: Type Descriptor:. Collected From: Bill to: Location’s/lndividual's Name. Name/Company^ Street__________________ Street i City/SVZip______________ _ City/St/Zip Identification of Source Phone#:, _______ Fax I CA.CH ~BI? Collection Point___JL_ Check#: Amounts.

BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLE/SOLID ANALYSES Lab#;____ ' '-s (circle tests) (circletests)' . ,/ ': ’’’ 1. Heterotrophic Plate J. Trihalomethanes (524) ; • 1. Purgeable Halocarbons (624/8260) - Count (hemodialysis & all others) 2. ColifCTm P/A (public supplies) ' 3. Coliform MPN (priv well, raw, stp) I Volatile Halocarbons (524) "Volatile Aromatics (524) 4. Total Trihalomethane Potential (510) 2. Purgeable Aromatics (624/8260) ‘ i 3. Acrolein & Acrylonitrile (624) 4. Phthalates (606/8060) 4. Fecal Coliform^(all samples) 5. Microextractables (504) 5. Organoch lorine 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) -

I 7. API PCB as Decachlorobiphenyl (508A) 8, Other Pesticides (SM-18/6630) 8. Other;. Herbicides (515) 9. Petroleum. Hydrocarbon Scan (310-13) ■. —jF Pesticides (525) 10. Glycols in Water Refrigerated? yes /ho Carbamate Pesticides (531) 11. Acid Extractables (625/8270) 12. Glyphosate (547) Base Neutral Extractables (625/8270) Chlorinated?: .yes no 13. Diquat (549) GC/MS'Unknown Scan 14. Chlorination Disinfection Byproducts (551) 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. Petroleu m/Hydrocarbon Scan (310-13) 17. PCB’s (Arochlors) (DEF)

pH.

INORGANIC ANALYSES REQUESTED - Lab#;. u.------ (circle tests) ’ST'

1. Color 20. Acidity 39. Aluminum 59. Potassium 2. T urbidity 21. Alkalinity, as CaCOa 40. Antimony 60. Seleniurh 3. pH 22. Bromide 41. Arsonic 61. Silver ; 4. Conductivity 23. Bromate/Chlorate/Chlorite 42. Barium 62. Sodium ' 5. Corrosivity (temp: .’C) 24. Chloride 43. Beryllium 63. Thalliurri 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 £LE 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 NI 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. Lead 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. IIV254 57. Molybdenum 75. TCLP-BNA’s 58. Nickel

NYC-WTC_000070571