Chain of custody record, Westchester County Department of Labs

NYC 9/11 Public Portal Document

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III ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road. Valhalla. New York 10595 (914)593-5575 Tirne/Date Set:__________ Form A-70 (rev. 1/96) orTtiK G C . - - ’ / Sample Type (circle one); i -7, ? ( VT7 Y VMfc J? Potable 3. Non-Potable Treked Bottle ys:C -t ■ i v. T?' cVr V / 7 ■'-/ t-1 ',4 , r.

'2. Non-Potable 4. Other BlillSllllllils Chain of Custody?, ves no ?/ ■ ■ . h TimeA3ate Collected:! Comments:■ li Collected By: IN- ’-FVC Agency Code; Source ID: Type Descriptor; Collected From; Bill to: Location’s/lndividual’s Name____ ! Pvt pr-.o! Name/Company 1 Street > '' P f r 4 Street Citv/svzip V-P-vUg Citv/SVZip Identification of Source i Phone#: Fax#; Collection Point C-- < I . * -'■■ . rCA?CKmZ ' Check#: Amounts

BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLE/SOL!D ANALYSES

lOiSilBSiBilSSO 1. Purgeable Halocarbons (624/8260) Count (hemodialysis & all others) 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 Trihalomelhane Potential (510)1 4. Phthalates (606/8060) • 4. Fecal Coliform (all samples) 5. Microextractables (504) 5. Organochiorine Pesticides (608/8080) Pesticides (507) 6. PCB’s (Arochlors) (608/8080) 6, Macroscopic Pesticides/PCB screen (508) 7. Herbicides (SM-18/6640; 8151) 7. API PCB as Decachlorobiphenyl (508A)l 8. Other Pesticides (SM-18/6630) 8, Other. ________ __ ______ _ 9. Herbicides (515) 9, Petroleum Hydrocarbon Scan (310-13) Pesticides (525) iu.CivcoisinWme; Refrigerated? yes no Hl. Carbamate Pesticides (531) 11, Acid Extractabies (625/8270) 12. Glyphosate (547) )2-Base Neutral Extractabies (625/8270) ■-13. Diquat (549) ^3/GC/MS Unknown Scan Chlorinated?: yes no 14. Chlorination Disinfection Byproducts (551) 14. Purgeable Halocarbons (DEF) ■i Free Chlorine Res:, mg/L I 15. Haioacetic Acids (552) 15. Purgeable Aromatics (DE;F) 16. Other Pesticides (SM-18/6630) 16. Pesticides (DEF) Total Chlorine Res: mg/L 17. Petroieum/Hydrocarbon Scan (310-13) 17. PCB’s (Arochlors) (DEF)

pH, I ■ INORGANIC ANALYSES REQUESTED .Itab#: = ; '(ejrillSsSiTillgillililiils^ H./Y / j 1, Color, ;2^ Aridity ’ ’ V 39. Aluminum ’2h.Alfelinity, as CaCOa <40? Antimony 60. Selenium 22,. Bromide 41. Arsenic 61. Silver ■ 23;"Brdmate/Chlorate/Chlorite 42. Barium 62. Sodium f ' 5.' Corrosivity (temp:; .°C) 24. Chloride 43.;Beryllium ,63. Thallium ; ■25. Cyanide 44. Boron '64. Vanadium 7. Soluble BOD (5 day) 26. Fluoride 45. Cadmium _65^ic___ i_______________ _ , 8- Carbonaceous BOD (5 day) 27. Hardness, Total as CaCOs 46. Calcium, as CaCOs 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 sBBBs 14. Solids, Settleabie ; •„ 33. Pheno! <52,.'lron .ICLP 15. Solids. Suspended ' 34. Phosphorus. Total as P 53. Lead TI.TCLP-Metals! I 1 16. Solids, Total 35. Phosphorus, Ortho as P ,54.'Magnesium 72. TCLP-Pesticii les 17. Solids, Total Dissolved 36. Sulfates /55.;Manganese 73.-TCLP-I rbi IB 37. Surfactan-. *6. M-v.-un; Pi

NYC-WTC_000070631