Chain of custody record, Westchester County Department of Labs

NYC 9/11 Public Portal Document

■I '88. 111 ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH iW S 2 Dana Road. Valhalla, New York 10595 Utesicbostertowiv (914)593-5575 , ijiHiliijllllll Time/Date Set: B- Form A-70 (rev. 1/96)

Sample Type (circle one): , Bx c TL'Cv < .. w O Non-Potabie Treated Bottle _® 2. :Non-Potable 4. Other, Chain of Custody? yes no Time/Date Collectad:. Comments: Collected By: Agency Code: IIBlilBiilil Source ID: Type Descriptor: Collected From: Bill to: Location's/lndividual's Name Name/Companv

__ SiiSel|i®iB®l®®88 City/SVZip_l£i_l®®_ji__^^ Citv/St/ZiP ___ Identification of Source. Phone#: Fax #: / B® Collection Point ■- . • Check#: Amounts

BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLE/SOLID ANALYSES

I Count (hemodialysis & all others) Volatile Halocarbons (524) 2. Coilform P/A (public supplies) 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) Pesticides (507) 6. PCB’s (Arochlors) (608/8080) )' I? BlftilBs<O|i®®Si®«®f®ii®f®l®8ll Pesticides/PCB screen (508) 7. Herbicides (SM-18/6640; 8151) IBIIIIIIIIIIB 8. PCB as Decachlorobiphenyl {508A) 9 Herbicides (515) 8. Other Pesticides (SM-18/6630) 9. Petroleum Hydrocarbon Scan (310-13) ’ ,

•Ji Pesticides (525) 10. Glycols in Water Refrigerated? yes no 11. Carbamate Pesticides (531) 11. Acid Exfractables (625/8270) ,,i 12. Glyphosate (547) tBBase Neutral Extractables (625/8270) 13. Diquat (549) Q^GC/MS Unknown Scan Chlorinated?; yes no ,14. Chlorination Disinfection Byproducts (551) 14. Purgeable Halocarbons (DEF) IB Free Chlorine Res;. mg/L 15. Haloacetic Acids (552) 15. Purgeable Aromatics (DEF) 16. Other Pesticides (SM-18/6630) Total Chlorine Res: ing/L •< 17. Petroleum/Hydrocarbon Scan (310-13)

pH.. - /i I

INORGANIC ANALYSES REQUESTED itab#;, ■i (circle tests) i T Bilslllillililiilili 1. Color , 2b. Acidity i|5|ij|(i|BHSBI8lilS®8 (59; Potassium ? 2. Turbidity 21;. Alkalinity, as CaCOa ^40. Antimony 60. Selenium , ? 3. pH ' 22;'Bromide 41, Arsenic 61. Silver - r IllllllillJ 4. Conductivity'J. - 23)Bi^'nnate/Chlora1e/Ch!orite 42, Barium .,62. Sodium 8(C 5. Corrosivity (temp:__ ____ “C) 24. Clfforide J43. Beryllium 63. Thallium .) 6. BOD (5 day) ,i25;C)Mnide 44. Boron ■ z'64. Vanadium t 7.,' Soluble BOD (5 day) 26. Fluoride 45. Cadmium '*65. Zinc - ■ ' " " 'CLP ■“ . 8. Carbonaceous BOD (5 day) 27. Hardness. Total as CaCOa 46. Calcium, as CaCO,; ,9. Chemical Oxygen Demand 28. Nitrogen, Ammonia as N 47. Calcium, Ca’*" 66. Metais/CN 10. Dissolved Oxygen 29. Nitrogen, Nitrate as N 48. Chromium, Total 67. Volatiles 11. Total Organic Carbon < 30. Nitrogen, Nitsite as N 49. Chromium, .......... Hexavalent ........... ........ 68. Semi-volatiles 12. Total Organic Halides '(31. Nitrogen, Total KjeldahJ as N 50. Cobalt 13. Solids, Percent (%) 32.-Oil and Grease ; i 51. Copper 14. Solids. Settleable 33.!Pheno! \ '' 5dhou ICLP 15 Solids. Suspended '34. t^hosphofus. Total'as P "SS. Lead 71, TCLP-Metals 16. Solids. Total 35. Phosphorus, Ortho asP ; 54. Magnesium 72. TCLP-Pesticides 17......... - Total ..................... - Solids, ...... - Dissolved^ 36. Sulfates -, ■ , f55; Manganese 73.-TCLP-Herbicides 18 Sohds. Total Volatile 37, Surfactants - ' ,56. Mercury 74. TCLP-Volatiles 1.9. Other; 38. UV254 .,,67. .Molybdenum P' IC! t« PNA s ■ ■ . . X • 58. Nickel _________________ i

NYC-WTC_000070632