Chain of custody record, Westchester County Labs, Nov 2001

NYC 9/11 Public Portal Document

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 NYS-ELAP No. 10108 Time/Date Set: ______________________ Form A-70 (rev. 1/96) Sample Type (circle one): 1. potable 3. Non-Potable Treated 2. Non-Potable 4. Other_____________ Chain of Custody? .yes .no Time/Date Collected:______ ' Comment8: Collected By: * -L A J A V■ LAgency Code:, PWS #:____ .Source.lD:. .Type Descriptor:. Collected From: Bill to: Location’s/lndividuars Name. Name/Company Street__________________ Street City/SVZip_______________ Citv/St/Zip Identification of Source Phone#:. • _Fax #:. Collection Point, i'Q 7 <5 |;CA.CH, Bl? - Check#: .Am6uiit$_l

BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES ;; ORGANIC NONPOTABLE/SOLID ANALYSES Lab#: _______________ Lab #: , (circle tests) (drctelosts) ■ '-Z' Y'/YY;’' 1. Purgeable HaiocarbpDs (6?^826e^ > 1. Heterotrophic Plate ^Trihalomrthanes (524) 5. 2. Purgeable Aromatics (62^82601 Count (hemodialysis & ail others) Volatile Halocarbons (524) 2. Coliform P/A (public supplies) Volatile Aromatics (524) /■'■/Ya. Acrolein & Acrylonitrile <624) 3. Coliform MPN (priv well, raw, stp) 4. Total Trihalomethane Potential (510) Phthalates (606/8060)' • 5. Microextractables (504) i '■ 5. Organochlorine Pesticides (608/8080) 4. Fecal Coliform (all samples) 5. Microscopic Pesticides (507) ■, 6. PCB’s (Arochlors) (608Z8Q60) 6. Macroscopic Pesticides/PCB scre^(508) 1 ' 7. Herbicides (SM-18/6640; 8151) 7. API 8. PCB as Decachlorpbiphenyl^SoSA) 8. Other Pesticides (SM-18/6630) 8, Other:___________________ Herbicfdes (515f 9. Petroleum Hydrocarbon Scan (310-13) (^Pesticides (525) , 10. Glycols in Water t:-? Refrigerated? .yes_____ no IT Carbamate Pesticides (531) 11.'Acid Extractables (625/8270) 12. Glyphosate (547) s .12, Base Neutral Extractables (625/8270) Chlorinated?; yes no 13. Diquat (549) . GC/MS.Unknown Scart 14. Chlorination Disinfection Byproducts (551) 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: .mg/L 17. Petroleum/Hydrocarbon Scan (310-13) 17. PCB's (Arochlors) (DEF),'

pH g INORGANIC ANALYSES REQUESTED - Lab#;. (circle tests) 1. Color 20. Acidity 39. Aluminum 59. Potassium 2. T urbidity 21. Alkalinity, as CaCOs 40. Antimony 60. Selenii^n 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 CLE 9. Chemical Oxygen Demand 28. Nitrogen, Ammonia as N 47. Calcium, Ca*2 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 TCLP 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.'.IV254 57. Molybdenum 75. TCLP-BNA’s 58. Nickel '

NYC-WTC_000070575