Chain of custody record, Westchester County Department of Labs

NYC 9/11 Public Portal Document

JL ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 , (914)593-5575 ’ ' Cl ' - NYS-ELAP No. 10108 Time/Date Set:_________ Form A-70 (rev. 1/96) Sample Type (circle one): OLi'ie? "7 S'I St 57F Caff

3. Non-Potable Treated 3r5o Potable 2. Non-Potable 4. Other_____________ Chain of Custody? .yes ----- .no i Time/Date Collected:. IKS'- 1 0, ^9^ Comments: Collected By:_ Agency Code:. PWS #:_________ .Source ID:Type Descriptor:. Collected From: Bill to: Location’s/lndividuars Name_____________________ Name/Company Street_________ _ ______________________________ Street__________ City/SVZip______________ ______________ City/St/Zip Identification of Source___ _ ________ Phone#: _Fax Collection Point I CA, CH. Bl? CheckjL Amounts.

BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLE/SOLID ANALYSES Lab#:___________ - Lab (circle tests) (drcleleste) 1i Heterotrophic Plate 1. Trihalomethanes (524) 1. Purgeable Halocarbons (624/8260) ; Count (hemodialysis & all others) A.J/GlaHe-Hatocaib'orts-CS^A) ^5^ 2. Purgeable Aromatics (624/8260) 2, Coliform P/A (public supplies) ^tofattfe-Aromatie^ 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. 5. Microscopic PCB’s (Arochlors) (608/8080) 6. Macroscopic Pesticides/PCB screen (508) 7. Herbicides (SM-18/6640; 8151) 7. AP! 8. PCB as Decachlorobiphenyl (508A) 8. Other Pesticide^SM-18/6630) 8. Other:. Herbicides (515) 9. Petroleum Hydraferbon Scan (310-13) L Pesticides (525) 10. Glycols in WateW Refrigerated? yes no 11. Carbamate Pesticides (531) 11. Acid Extractabfe"(625/8270) 12. Glyphosate (547) IZ Base Neutral extractables (625/8270) Chlonnated?: yps no 13. Diquat (549) Q^GC/MS Unknown Scan 14. Chlorination Disinfection Byproducts (551) 14. Purgeabie Halocarbons (DEF) Free Chlorin^ Res:. -------- X mg4. 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)

J. pH

INORGANIC ANALYSES REQUEStED ^ Lab#: (circle tests) ^0. Apidity ./ /' 7 — 7 1. Color 39. Aluminum 59. Potassium 2. T urbidity I .7^. AlKalinity, as CaCOa 40. Antimony 60. Selenium i 3. pH Bromide 41. Arsenic 61. Silver 4. Conductivity 23. B'romate/Chlorate/Chlorite 42. Barium 62. Sodium 5. Corrosivity ftemp:' .°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 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 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_000070653