Chain of custody record, Westchester County Labs, Nov 2001

NYC 9/11 Public Portal Document

JU. ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 (914) 593-5575 NYS-ELAP Nd; 10108 Tirhe/Date Set: ____________________________ Form A-70 (rev. 1/96) ^gpmple Type (circle one): ^WPotable 3. Non-Potable Treated Bottle#’8: Y /. 7^^, >>> V/

2. Non-Potable 4. Other_________________ __ Chain of Custody? .yes .no Time/Date Collected- Comments: Collected By:. Agency Code:_ PWS#:________ .Source ID:. .Type Descriptor:i Collected From: -e Bill to: Location’s/lndividual’s Name_ ^073 Name/Company Street_____________ L—__________________ Street__________ City/St/Zip______________:_____________________ City/St/Zip______ Identification of Source______ 7_____ _________ _ Phone#:. _Fax #:. Collection Point. I CA. CH, Bl?. Check#:_____ Amounts.

BACTERIOLOGICALANALYSES ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLE^LID AN^ySES 1 ah#- - Lab (ctrcteteste); ■ ' (circle tests) ' : 1. Heterotrophic Plate .) ’ ;■ 7 j. Trihalomethane® (524) 1. Purgeable Halocarbons (624/^60^1 Count {hemodialysis & all others) 2. Purgeable Aromatics (624/M60i^^S 2. Coliform P/A (public supplie's) 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 (608/808Q) 5. Microscopic 6. Pesticides (507), _ '6. PCB’s (Arochlors) (608/8080) . , 6. Macroscopic 4tMieideaAiefr8«MMa4SflSI^^ 7. Herbicides (SM-18/6640; 8151) 7-API 8. PCB as Decachlorobiphenyl (508A) 8. Other Pesticides (SM-18«63O) '’^J?7.;^; 8. Other: ' 7 9- Herbicides (515) 9. Petroleum Hydrocarbon Scan (310-13) P«wi«idrie8(5?5) ■ 10. Glycols in Water Y Refrigerated? yes no • 11. Carbamate Pesticides (531) 11. Acid Extractables (625/8270) ' //Y; 12. Glyphosate (547) U,Base Neutral Exliaetablas (626/8270) Chtonnated?: .yes___ _no ; 13. Diquat (549) GC/MS Unknown Scan ' 14. Chlorination Disinfection Byproducts (551) 1^. Purgeable Halocarbons (DEF) Free Chlorine Res:. .mg/L ,15. Haloacetic Acids (552) 15. Purgeable Aromatics (DEF) 16. Other Pesticides (SM-18/6630) 18. Pesticides (DEF) Total Chlorine Res: a .mg/L • ,17. Petroleum/Hydrocarbon Scan (310-13) 17. PCB’s (Arochlors) (DEF) y. pH.......... ........ INORGANIC ANALYSES REQUE^j^D^ab#: | . f -

(circle tests) V V' 1. Color 'K ’'2C Aridity 39 Aluminum 59. Potassium 2. Turbidity Ajblinity, as CaCOa 40, Antimony Selenium 3. pH :2|.;Bfe^ido 41 Arsenic Silver 4. Conductivity .23. Bromate/Chlorate/Chlorite 42 Barium 62. Sodium 5. Corrosivity (temp:°C) Chloride Beryllium 63. Thallium a 6. BOD (5 day) / 4S», Cyanide 44. Boron & Vanadium 7. Soluble BOD (5 day) 26. Fluoride 45. Cadmium 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 '^lO. 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 ^Cobalt 69. Pesticides/PCB’s 13. Solids, Percent (%) 32. Oil and Grease f51 Copper 70. Disk Deliverables 14. Solids, Settleable 33. Phenol 152 Iron isle 15. Solids. Suspended 34. Phosphorus. Total as P Lead 71. TCLP-Metals 16. Solids, Total 35. Phosphorus, Ortho as P j2z- Magnesium 72. TCLP-Pesticides 17. Solids, Total Dissotved 36. Sulfates Manganese 73. TCLP-Herbicides f 18.. Solids. T^l Volatile 37. Surfactants 56J Mercury 74. TCLP-Volatiles Y^Other: • _______ 38. UV254 Molybdenum 75. TCLP-BNA’S 58/ Nickel y

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