Chain of custody record, Westchester County Lab, Nov 2001

NYC 9/11 Public Portal Document

C'k," ;''i ■ ; . • , ' ENVIRpNMENtAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH hi 2 Dana Road. Valhalla, New York 10595 '• . (914)593-5575 ■ NYS-ELAP No. JOjCs ’ ^ 'ime/Date Set:________________ Form A-70 (rev. 1/%; ' VSample Type (circle one): c 05iz. ' 3. Non-Potable Treated Bottle #-s:^ W.m 1/ 1,Non-Potable 4. Other _______ Chain of Custody? .yes no Time/Date Collected: ***7^0 Comments:; A- Collected Bv:^\ ■ 'I Agency Code: _ PWS #:_________ Source ID:, Type Descriptor:. Collected From: Bill to: Locafion’s/lndividual’s Name Name/Company _ Street__________ City/st/ZiD lH yuv/C' _ City/St/Zip Identification of Source________ _____________ — Phone#: _Fax #: Collection Point Def- I I CA. CH. Bl?. Check#:. Amounts.

BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLE/SOLID ANALYSES I ab#: • • ■_____________ Lab #:___________ :________________ -(circle tests) (drr.le tests) 1.‘Heterotrophic Plate 1. Trihalomethanes (524) 1. Purgeable Halocarbons (624/8260). Count (hemodialysis & all others) ''2!^ Volatile Halocarbons (524) 2. Purgeable Aromatics (624/8260)' 2. Coliform P/A (public supplies)’ 3,/ Volatile Aromatics (524) 3. Acrolein & Acrylonitrile (624) ■ ■ S. poliform 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 7. Pesticides/PCB screen (508) 7. Herbicides (SM-18/6640; 8151) 17. API ■ , 8. PCB.as Decachlorobiphenyl (508A) 8. Other’Pesticides (SM-18/6630) ‘ lOther: ■9. Herbicides (5l 5) - .9. Petroleum Hydrocarbon Scan (310-13) ’Mt- io. Pesticjdes'(525) 'J 10. Glycols in Water jReffigerated?yes _____no;^ ill. Carbarriate Pesticides (531) 11. Acid Ext'ractables (625/8270) - ' ■, ' t! Chlpnnated?:yes. " ____ no !i2.'Glyphosate (547) '13. Diquat (549) , ' - ' 12 Base Neutral Extractables (625/8270) M3./GC/MS Unknown Scan J 4, Chlorination Disinfection Byproducts (551) 14. Purgeable Halocarbons (DEF) ' -Free Chlorine Res:mg/L? "^15. Haloacetic Acids (552) 15. Purgeable Aromatics (DEF) ■ie.’Other Pesticides (SM-18/6630) , . 16. Pesticides (DEF) Total'Chlorine Res: •17. Petroleum/Hydrocarbon Scan (310-13) 17. PCB’s (Arochlors) (DEF)

kpH.-.- ________ iii f I . i I^ft^ANIC ANALYSES REQU^^t^ab#: / o wi ■ -

39. Aluminum ,,T .5 / U/'l | \ 59. Potassium Turbidity » Salinity, as CaCOa ' (50,^Antimony. | V LL- ' 60. Selenium .fj^^.'^^mide MS pk ■-' 41. Arsenic 61. Silver . Conductivity Bmmate/Chlorate/Chlorite. . 42. Barium 62,. Sodium / Corrosivity (temp:___ 'C)'«Wide 0- /.4:p Beryllium ^^.h’hallium |B©C(5'day) ■4'4. Boron 64. Vanadium f^Soluble ElOD (5 day) - 45. Cadmium 65. Zinc '. Carbonaceous BpD (5 day) 27. Hardfiess, Total as CaCOa 46. Calcium, as CaCOa CLP- Qhemical O'xygen'Demand ■ 28. Nitrogen, Ammonia as N ' ' • 47. Calciufri/Ca*’......... 66. Metals/CN. fe^’ISdlved pxygeh . 29. Nitrogen.' Nitrate as N •i AS.'Chromium, Total 67. Volatiles ’ O^'tltOrganjc Carbon..- 30.Nitrog6n..NitriteasN ' 49 ■ Chrorniurp; Hexavalent 68.;Semi-volatiles OMUI Prg.anTc. Halides 31 • Nitrogen, Total Kjeldahl as N (§0-? CoBilt " ■ 69. Pesticides/PCB’s. SBWids,. Percent (%). 32..Oil and .Grease. .. ’ ' 7b.-Disk Deliverables . ... ^.Copper W dSjjSettle’^ble 33.,^enbJ;; . , ^^Uron TCLP^ ■ Suspend^.’ : - .34-tPhosph-brus;-Jotal asP.; /S^jLeadJ ,71.,TCLP-Metals;' , BJililJe. Totaly '35^.- Phosphorus, .Ortho.as,P> &4 M.agnesiurh' .■72/Tt'LR-P;estildss .^Sulfates'/ g5;-'Manganese- , 73: TCLg-Hefbicidesj II 37.''Sur< actants.* » Jtl'tctg-Volafilesj. 38.41^2^’ ’ / '■H ;^<TCLe-BNA:s. ■ . .^^ Nickerv' :

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