Chain of custody record, Westchester County Department of Labs

NYC 9/11 Public Portal Document

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FOrM WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, Naw York 10595 (914) 593-5575 "NYS-ELAP No. 10108 Time/Date Set: '_____________ ________________ Form A-70 (rev. 1/96) Sample Type (circle one): i' Potabj^ ,3. Non-Potable Treated Bottle #’s:P* , ■ ■ •7 - V

2. Non-Potable . 4. Other _____________ Chain of Custody? .yes no Time/Date Collected: QI _______ L Comments: Collected By:. .Agency Code: PWS ________ .Source ID:. .Type Descriptor:. Collected From: Bill to: Location’s/individuars Name Name/Company Street ' \ ' -_________ —____ ____ Street______________ Citv/SVZip '** ' ■ : ___________________ City/St/Zip___________ identification of Source ______ Phone#: _Fax #:, Collection Point. ■ - ■ Q .Co I CA,CH. Bl? Check#: Amounts

BACTERIOLOGICAL ANALYSES . ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLE/SOLID ANALYSES < Lab#: ____ (drcletesl?)./ ; (ctrdetests) ... .' 1. Heterotrophic PIate J : Trihalomethanes (524) 1. Purgeable Halocarbons (624/8260) Count (he.modialysis&allpthers) 4telat4le44atecatbons;(S241 2. Purgeable Aromatics (624/8260) 2. Coliforrh P/A'(public.suppires) . . “VotatiteTSrTOmalte^ . 3. Acrolein & Acrylonitrile (624) 3. Coliform MPN ^riv 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) 5. Microscopic '. §. Pesticides (507) 7 '6. PCB's (Arochlors) (608/8080) 6. Macroscopic, ... ■0 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: - ' ' Y • gi 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) 1^ Base Neutral Extractables (625/8270) Chlorinated?; ves ' no 13. Diquat (549) GC/MS Unknown Scan 14. Chlorination Disinfection Byproducts (551) 14. Purgeable Halocarbons (DEF) Free Chlorine Res:. .mg/L 15. Hapacetic 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 I — INORGANIC ANALYSES REQUESTED - Lab#:. (circle tests) 1. Color 20. Acidity 39. Aluminum 59. Potassium 2. Turbidity 21. Alkalinity, as CaCOs 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)I 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 CaCOa 46. Calcium, as CaCOa CLE 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 TCLP 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_000070657