Chain of custody record, Westchester County Labs, Nov 2001

NYC 9/11 Public Portal Document

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JL ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM ? WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, Naw York 10595 (914) 593-5575 'S-ELAP No. 10108 TimeZDate Set:________ Form A-70 (rev. 1/96) Sample Type (circle one); 1. Potable^ 3. Non-Potable Treated Bottle 2. Non^Potable 4. Other___________ Chain of Custody? .yes .no < Time/Date Collected:. Comments: Collected By:, .Agency Code:. PWS#:_______ _ .Source ID:. .Type Descriptor.. Collected From: Bill to: Location’s/lndividual's Name. 3 Name/Company Street_____ ___________ Street_________ City/SVZip_____________ City/St/Zip Identification of Source Phone#:, _Fax»:_ Collection Point- <2 I CA. CH, Bl? Check#:_____ Amounts. ■-if": ;. I-.,-. •

BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLE/SOLIPMALYSES Lab#: : Lab«:____________________ (drctetests) - i*;; (circle tests) i 1. Purgeable Halochifel^^^^^^# 1. Heterotrophic Plierte ' jJ^Trihalomelhanes (524) Count (hemodialysis & all others) Volatile Halocarbons (524) 2. Purgeable Arornattaidfejla^'*^^ .2. Coliform P/A (public supplies) Volatile Aromatics (524) 3. Acrolein & Acryl6hftMle1^24W^ 3. Coliform MPN (priv well, raw, stp) 4. Total Trihalomethane Potential (510) 4. Phthalates (606/8060)'' i >' X i 4. Fecal Coliform (all samples) 5. Microextractabies (504) 5. Organochlorine Pesticides (608/8080) 5. Microscopic 6. Pesticides (507) '6. PCB’s (Arochlors) (608/8080) '6. Macroscopic . 7. Pesticides/PCB screen (508) 7. Herbicides (SM-18/6640; 8151) Y v, 7. AP! 8. PCB as Decachlorobiphenyl (508A) 8. Other Pesticides (SM-18/6630) i 8. Other:_________________ 9. Herbicides (515) 9. Petroleum Hydrocarbon iScim (310-13) 10. Pesticides (525) 10. Glycols in Water - ■ ' : Refrigerated? yes no 11. Carbamate Pesticides (531) 11. Acid Extractables (625/8270) 12. Glyphosate (547) t2s,Base Neutral Extractables (62^8270) Chlorinated?: .yes no 13. Diquat (549) ^2‘C/MS Unknown Scan'/ 14. Chlorination Disinfection Byproducts (551) Purgeable Halocarbons (DEFf Free Chlonne Res>. .mg/L 15. Haloacetic Acids (552) T5*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)

PtL X INORGANIC ANALYSES REQUESTED ilab#:. (circle tests) 1. Color , 20. Acidity '391 Aluminum . . | . 1 59. Potassium 2. Turbidity - 21. Alkalinity, as CaCOs 40.lAntimony ' i' Selenium 3. pH 22. B^mide 41.|Arsenic Silver 4. Conductivity 23, Bromate/Chlorate/Chlorite 42.tBarium Sodium 5. Corrosivity (temp: .’C) 24. Chloride \^Boryllium Thallium 6. BOD (5 day) 25. Cyanide Boron Vanadium 7. Soluble BOD (5 day) 26. Fluoride 45. Cadmium ^5? Zinc_________________ 8. Carbonaceous BOD (5 day) 27. Hardness, Total as CaCOs 46. Calcium, as CaCOs fitE 9. Chemical Oxygen Demand 28. Nitrogen. Ammonia as N 4r Calcium, Ca*’ 66. Metals/CN 10. Dissolved Oxygen 29. Nitrogen, Nitrate as N ^/Chromium, Total 67. Volatiles 11. Total Organic Carbon 30. Nitrogen, Nitrite as N Chromium, Hexavalent 68. Semi-volatiles 12. Total Organic Halides 31. Nitrogen, Total Kjeldahl as N z*§0.^obalt 69. Pesticides/PCB’s 13. Solids, Percent (%) 32. Oil and Grease I Sl.jCopper 70. Disk Deliverables________ 14. Solids, Settleable 33. Phenol t 52.;iron ISLE 15. Solids, Suspended 34. Phosphorus. Total as P M3/Lead 71. TCLP-Metals 16. Solids. Total 35. Phosphorus, Ortho as P 54. Magnesium 72. TCLP-Pesticides 17. Solids, Total Dissolved 36. Sulfates j^.' Manganese 73. TCLP-Herbicides 18. Solids. Total Volatile 37. Surfactants j 56. Mercury 74. TCLP-Volatiles 19. Other:_______________ 38. UV254 ■ 57. Molybdenum 75. TCLP-BNA’s y V58/Nickel 4"

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