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 ■

NYS-ELAP No. 10108 Time/Date Set:_________ Form A-70 (rev. 1/96) Sample Type (circle one): I 7

1. Potable 3. Non-Potable Treated Bottle #'s: 2. Non-Potable 4. Other_____________ Chain of Custody? .yes no Time/Date Collected:. fl i • > ) Comments: I Collected By: .Agency Code: _ PWS #:_________ Source ID:, .Type Descriptor. Collected From: mil to: Lpcation’s/lndividual's Namo_ / Name/Company Street_______________ ' _ :/ Street______ j_ City/St/Zip________ _ _ Citv/St/ZiD Identification of Source______ _____ — Phone#:. _Fax #:, Collection Point \ ► _ ICA, CH, B1?^- Check#: Amounts. ORGANIC POTABLE ANALYgj^S ORGANIC NONPOTABLE/SOLID ANALYSES BApTERIQLOGICAL ANALYSES ■Lai>#:__^<__i_X^— (circle teste) 1. Het^otrophic Plate V ■ (circle tests) JL Trihalomethanes (524) . II :,;W 1. Purgeable Halocarbons (624/8260);’^^®: Count (hemodfatysis & all others) Volatilo HaloeWns^tSg#)"— 2. Purgeable Aromatics (624/8218^/!'®^ 2. Coliform P/A (public supplies) _ i>a/^vuijritirArerf'i^ito(5e4). ' 3. Acrolein & Acrylonitrile '(624) ' 3. .Coliform MPN (priv well, raw, stp) 4. Total Trihalomethane Potential (510) 4. Phthalates (606/8060) Y , . 4. Fecal Coliform (all samples) 5. Microextractables (504) 5. Organochlorine Pesticides (608/8080) ■ 5. Microscopic 6. Pesticides (50^5* 6. 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 Pesticides (SM-18/6630) 8. Other:_________________ __ 9,. Herbicides (515) 9. Petroleum Hydrocarbon Scan (310-13) Pesticides (525) 10. Glycols in Water Refrigerated? .yes no 11. Carbamate Pesticides (531) 11. Acid Extractables (625/8270) 12. Glyphosate (547) 12. Base Neutral Extractables (625/8270) Chlorinated?: yes no 13. Diquat (549) @ GC/MS Unknown Scan •( 14. Chlorination Disinfection Byproducts (551) 14. Purgeable Halocarbons (DEF) Free Chlorine Res:. 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) 41 £H

INORGANIC ANALYSES RE'QUESTED ^ib#:. (circle tests) 1. Color 2^ Acidity . 39. Aluminum 59. Potassium 2. Turbidity 4 2't. Alkalinity, as CaCOs 40. Antimony 60. Selenium 3. pH / 2^; Bromide 41. Arsenic 61. Silver 4. Conductivity Bromate/Chlorate/Chlorite 42. .Barium 62. Sodium 5. Corrosivity (temp: 6. BOD (5 day) .•o 241 Chloride 43. Beryllium 44. Boron 63. Thallium 64. Vanadium 25; Cyanide 7. Soluble BOD (5 day) 26. Fluoride 45. Cadmium 65. Zinc__________ 8. Carbonaceous BOD (5 day) 27. Hardness, Total as CaCOa 46. Calcium, as CaCOs CLP 9. Chemical Oxygen Demand 28. Nitrogen, Ammoniwas N 47. Calcium, Ca*-^ 66. Metals/CN ' 10. Dissolved Oxygen 29. Nitrogen. Nitrate 30. Nitrogen, allL^ Nitrite as 1^"^" ' 49;clf^miu^'’i^Txavalent 67. Volatiles 11. Total Organic Carbon 68. Semi-volatiles 12. Total Organic Halides 31. Nitrogen, Total Kjeldahl 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 letp 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 ■1^

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