Chain of custody record, Westchester County Department of Labs

NYC 9/11 Public Portal Document

JI ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER/:OUNTY LABORATORIES ANO 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): ft • txt 1^ ''Potable 3. Non-Potable Treatad » Bottle #'s: V "KT. 2. Non-Potable 4. Otheri_l_______ I Chain of Custody? Jt—yes no Time/Date Collected: * CO Comments: Collected By: Agency Code: PWS #:________ _ .Source ID:. .Type Descriptor:. Collected From: Bill to: Location’s/lndividual’s Name »________________ Name/Company Street____________ _____ _________________________ Street__________ City/SVZip _______________________________ City/St/Zip Identification of Source____________ ' *___________ Phone#:________ .Fax #:_ I CA.CH. Bl? Check#: . Amounts. Collection Point —

BACTERIOLOGICAL ANALYSES u .ORGANIC POTABLE ANALYSES, ORGANIC NONPOTABLE/SOLID ANALYSES Lab#:___7J2770i-_ Lab'#:____£_____717.__7/'^ (drde tests), . (drcte tests) ? • *4 K Heterotrophic Plate 1? Trihalomethanes (524) 1. Purgeable Halocarbons (624/8260) Count (hemodialysis & alt others) A/eie(tle<Ha1eearbefls4624^ —- 2. Purgeable Aromatics (624/8260) 2. Coliform P/A (public supplies) -vofaYiorsTnsmcs'(^4)~ 3. /Acrolein & Acrylonitrile (624) 3. Coliform MPN (priv well, raw, stp) 4. Total Trihafomethane Potential (510) 4. Phthalates (606/8060) 4. Fecal Coliform (all samples) • 5. Microextractables (504) 5. Organochlorine Pesticides (608/8080) ‘6. PCB's (Arochlors) (608/8080) 5. Microscopic Pesticides (507) 6. Macroscopic Pesticides/PCB screen (508) 7. Herbicides (SM-18/6640; 8151) 7. API 8. PCB as Decachlorobiphenyl (508A) 8. Omer Pesticides (SM-18/6630) 8. Other:___________ '_______ • .9. Herbicides (515) 9. Petroleum Hydrocarbon Scan (310-13) Pesticides (525) 10. Glycols in Water Refrigerated? yes no Carbamate Pesticides (531) 11. Acid Extractables (625/8270) 12. Glyphosate (547) Base Neutral Extractables (625/8270) Chlorinated?: .yes-------- no 13. Diquat (549) GC/MS Unknown Scan 14. Chlorination Disinfection Byproducts (551) Purgeable Halocarbons (DEF) Free Chlorine Res:. 1__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 A _______________________ <' x;? - INORGANIC ANALYSES REQUESTI^D ^b#: 7?^ (circlo tests) i7 /V 1. Color 2^A^ity 39. Aluminum 59. Potassium 2. T urbidily ap Alkalinity, as CaCOa 40. Antimony 60. Selenium 3. pH 22/ Bromide 41. Arsenic 61. Silver 4. Conductivity 23. Bromate/Chlorate/Chlorite 42. Barium 62. Sodium 5. Corrosivity (temp: .’C) 24. CWOride 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 OLE 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 737. Surfactants 56. Mercury 74. TCLP-Volatiles 19. Other:_____________ ; 38. IIV254 57. Molybdenum 75. TCLP-BNA’s 58. Nickel

NYC-WTC_000070656