Chain of custody record, Westchester County Labs, Nov 2001

NYC 9/11 Public Portal Document

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM UtelSl^^lLty 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 #’8:V> . 2. Non-Potable 4. Other_____________ Chain of Custody? .yes no Time/Date Collected: X> \. 1 Comments: Collected Bv: A .Agency Code:. PWS Source ID: Collected Fror^ Bill to: ; ; Location’s/lndivkluars Name Name/Company Street _____________________ City/SVZip____________________________ City/St/Zip Identification of Source____________;_____ Phone#: _Fax T Collection Point, v < » ■- । I CA,fcH, Bl? ' Check#: Amounts ' Y

BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES/,.;, ORGANIC NONPOTABLE«OLID ANALYSES, Lab#:______________________ Lab (circle tests) (drcie'iosts) 1. Heterotrophic Plate i. Trihaiomethaned(524) ‘ 1. Purgeable HaiocarbdhgXl^iB260)"i'i?i?7'^ Count (hemodialysis & all others) Volatile Halocarbons (524) '. . '; <2.‘ Purgeable Aromatics (624/5260) ' ; / 2. Coliform P/A (public supplies) 4/ Volatile Arprriafics (524) ; ;3. Acrolein & Acrylonitrile (624) < . 3. Coliform MPN (priv well, raw, stp) 4. Total Trihalbmethahe Potential (510) i = ; ^4. Phthalates (606?8060) 4. Fecal Coliform (all samples) 5. Microextractables (504) 5. Organochlorine Pesticides (608/8080) ’ * 5. Microscopic ek Pesticides (507) < 6. PCB’s (Arochlors) (608/8080) '; 6. Macroscopic Pesticides/PCB screen (508/ 7. .Herbicides(§M-1 ^6640;8151) 5 7. API 8. PCB as Decachlorobiphenyi (508A) -8. Other Pesticides (SM^MbSO) ' 8. Other:___________________ 9,,^ Herbicides (515) 9. Petroleum Hydrocarbpn Scan (310-13) @ Pesticides (525) 10. Glycols in Water S 11. Acid Extractabies (625/8270) Refrigerated? .yes_____ no 11. Carbamate Pesticides (531) ■ ' 12. Glyphosate (547) 1^. Base Neutral Extractabies (625/8270) Chlorinated?: .yes no 13. Diquat (549) ■ ^^GC/MS.Unknown Scan ; 14. Chlorination Disinfection byproducts (551) lT 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/Hydfocarbon Scan (310-13) 17. PCB’s (Arochlors) (DEF) § ) ___ . ’

pH 3 INORGANIC ANALYSES REQUESTED - Lab#: (circle tests) f 1. Color 20. Acidity 39. Aluminum 59. Potassium' 2. T urbidity 21. Alkalinity, as CaCOa 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 CaCOs 46. Calcium, as CaCOa CLP 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. 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. UV254 57. Molybdenum 75. TCLP-BNA’s 58. Nickel .

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