Chain of custody record, Westchester County Labs, Nov 2001

NYC 9/11 Public Portal Document

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): 1. Potabjh 3. Non-Potable Treated Bottle #’s: C a: fl; 2. Non-Potable 4. Other___________ Chain of Custody? .yes .no Time/Date Collected:. 7 ///^/ / JI Comments: Collected By: f .Agency Code: PWS#:___________ .Source ID:. .Type Descriptor;. Collected From: Bill to; Location’s/lndividuars Name____ 51 Name/Company___ _ Street_______________ _____ Street City/St/Zip__________________ City/St/Zip___ Identification of Source________ Phone#:_ Fax#:. Collection Point, I CA, CH, Bl? Check#: Amounts,. ■

BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLE/SOLIDANALYSES Lab#;_________ Lab #:_____________________ I-.-. \ ; (dfdo tests). > (circle tests) 1. Purgeable Haidcah^^^^) <^ •“ 1. Heterotrophic Plate JL Trihalomethanes (524) Count (hemodialysis & all others) Volatile Halocarbons (524) 2. Purgeable Aromatics (624^260) 2. Coliform P/A (public supplies) Volatile Aromatics (524) 3. Acrolein & Acrylonitril^24j // ' 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 P8sticides (608/8080) 5. Microscopic 6. Pesticides (507) 6. PCB’s (Arochlors) (60^8080) . , 6. Macroscopic 7. Pesticides/PCB screen (508) 7. Herbicides (SM-18/6640; 8151) 7. API 8. PCB as Decachlorobiphenyl (508A) 8. Other Pesticides (SM-T8/6630) 8. Other:_________________ 9. Herbicides (515) 9. Petroleum Hydroca^on Scan (310-13) 10. Pesticides (525) 10. Glycols in Water / ' Refrigerated? yes____ no 11. Carbamate Pesticides (531) 11. Acid Extractables ^25/8270) ; 12. Glyphosate (547) ^Base Neutral Extractables (625/8270) Chlonnated?: .yes no 13. Diquat (549) QS/GC/MS Unknow#Scan 14. Chlorination Disinfection Byproducts (551) 14. Purgeable Halocarbons (DEF) Free Chlorine Res:. .nng/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)

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INORGANIC ANALYSES REQUESTED -Lab#: (circle tests) X. 1. Color 2. Turbidity 3. pH 4. Conductivity 20} Acidity \2i - Alkalinity, as CaCOa '2l2i Bromide 20. Bromate/Chlorate/Chlorite /39.’Aluminum ■ 40. Antimony ; 41. Arsenic ‘ 42. Barium (5 Potassium Selenium Silver 62. Sodium 5. Corrosivity (temp: ’C) "241 Chloride \43/Beryllium Thallium 6. BOD (5 day) 25. Cyanide 44. Boron ^Vanadium 7. Soluble BOD (5 day) 26. Fluoride 45. Cadmium SZiUC—— 8. Carbonaceous BOD (5 day) 27. Hardness, Total as CaCOs 46. Calcium, as CaCOa 9. Chemical Oxygen Demand 28. Nitrogen, Ammonia as N 47. CateiurrvCa*’ 66. MetaisZCN V)

' 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 •S3. Lead 71. TCLP-Metals 16. Solids, Total 35. Phosphorus, Ortho as P ^4. Magnesium 72. TCLP-Pesticides 17. Solids, Total Dissolved 36. Sulfates /'55< Manganese 73. TCLP-Herbicides 18. Solids. Total Volatile 37. Surfactants 56.'iMercury 74. TCLP-Volatiles . 19. Other:_______________ 38. UV254 . 57/Molybdenum 75. TCLP-BNA’s IsaNickel

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