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. Potabi^ 3. Non-Potable Treated Bottle Ay/ 2. Non-Potable 4. Other____________________ Chain of Custody? .yes .no Time/Date Collected:. w/oi/Qi y-~ Comments; Collected By:____________ .Agency Code: PWS #:_________ .Source ID:. jType Descriptor:. Collected From; Bill to: Location’s/lndividuars Name. Name/Companv Street________________ Street_________ City/SVZip_________ ■ City/St/Zip Identification of Source__ Phone#:_ _______ Fax #:. CollectionPoint. I CA. CH ■Bl? Check#: MmountS

BACTERIOLOGICAL ANALYSES ORGANIC PQTABLE.ANALYSES ORGANIC NONPOTABLE/SOLID ANALYSES Lab#: Lab. (circle tests) (circletests) 1. Heterotrophic Plate • tribalomethanes (524) 1. Purgeable Halocarbons (624/8260) Count (hemo^alysis & all others) 2. Purgeable Aromatics (624Z8260) 2. Coliform P/X^ublic 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) 5. Microscopic 6. Pesticides (507) 6. PCB’s (Arochlors) (608/8080) 6. Macroscopic •** Pesticides/PCB screen (508) 7. Herbicides (SM-18/6640; 8151) 7. AP! 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 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) Purgeable Halocarbons (DEF) Free Chlorine Res:. 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

INORGANIC ANALYSES REQUESTED - Lab#:. (circle tests) 1. Color 20. Acidity 39. Ajluminum 59. Potassium 2. Turbidity 21. 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. 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 BOO (5 day) 27. Hardness. Total as CaCOa 46. Calcium, as CaCOs CL£ 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. UV254 57. Molybdenum 75. TCLP-BNA’s 58. Nickel

NYC-WTC_000070659