Chain of custody record, Westchester County Lab, Nov 2001

NYC 9/11 Public Portal Document

III ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 - UlMtchMtar County (914) 593-5575 NYS-ELAP No. 10108 Time/Date Set; C- 0 546 Form A-70 (rev. 1/96) Sample Type (circle one): '77'7 - 'fKS-- / l.yPotable 3. Non-Potable Treated Bottle- (flu — ----- <.1,4-1 -Z Non-Potable 4. Other Chain of Custody? .yes no Time/Date Collected: / * 0/ >■ : S 2 Comments; Collected By:. Agency Code: PWS #■._________ Source ID: Type Descriptor: Collected From: Bill to; Location’s/lndividual's Name____ Name/Company Street______________________ Street__________ City/SVZip________ -__________ City/St/Zip Identification of Source Phone#:________ Fax #: Collection Point, I CA. CH, Bl?. Check#: Amounts

BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLE/SOLID ANALYSES Lab#:______________________ Lab #: V (circle lesls) (circle lesls) > ‘J Trihalomethanes (524) 1. Purgeable Halocarbons (624/8260) 1. Heterotrophic Plate Count (hemodialysis & all others) Volatile Halocarbons (524) , '* 2. Purgeable Aromatics (624/8260) 2. Coliform P/A (public supplies) Volatile Aromatics (524) 3. Acrolein & Acrylonitrile (624) 3. Coliform MPN (priv well, raw, stp) 4.' Total Trihalome'thane Potential (510) • 4. Phthalates (606/8060) / 4. Fecal Coliform (all samples) 5. ^icr^pxtractables (504) 5. Organochlorine Pesticides (608/8080) 5. Microscopic Pesticides (507) 6. PCB’s (Arochlors) (608/8080) 6. Macroscopic "Pesficide^PCB screen (508) 7. Herbicides (SM-18/6640; 8151) 7. API B. PCB as Decachlorobiphenyl (508A) 8. Other Pesticides (SM-18/6630) 8. Other; . ^Herbicides (515) ' 9. Petroleum Hydrocarbon Scan (310-13) ItJ^&sticides (525). 10. Glycols in Water, ...Refrigerated? ' yes____ no IT Carbamate Pesticides (531) 11. Acid Extractables (625/8270) 12; Glyphosate (547) 12. Base Neutral Extractables (625/8270) '■'iKi flS^C/MS Unknown Scan Chlorinated?: .yes. rio 13, Diquat (549) | .14, Chlorination Disinfection Byproducts (551) TatfPurgeable Halocarbons (DEF) Free Chlorine Res:. .mg/L 15, Haidacetic Acids (552f f 15. Purgeable Aromatics (DEF) 16, Other, Pesticides (SM-l'8/6630) j. 16. Pesticides (DEF) / Total Chlorine Res: Z mg/L ' 17, Petroleum/Hydfbcarbon Scan (3W-13) 17. PCB's (Arochlors/(DEF)

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INORGANIC ANALYSES REQUESTED; Lab#;JI (circle tests) J

1. Color 20., Acidity Z3aL Aluminum Potassium 2. Turbidity 21. Alkalinity, as CaCOa I 401 Anthony iSelenium 3.. pH 22. Bromide I 41.1Ars^ic Silver 4. Conductivity 23, Bromate/Chlorate/Chlorite I 42.lBar®m 62. Sodium 5. Corrosivity (temp: .’C) 24. Chloride > X^BerSlium ^Thallium 6. BOD (5 day) 25. Cyanide 44. Bor^ 64. Vanadium 7. Soluble BOD (5 day) 26. Fluoride 45. Cadmium Zinc__________ 8. Carbonaceous BOD (5 day) 27.,.Hardness, Total as CaCOs 46. Calcium, as CaCOa "CLP 9. Chemical Oxygen Demand 28. Nitrogen, Ammonia as N 47. 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 , 49. Chromium, Hexavalent 68. Semi-volatiles 12, Total Organic Halides 31. Nitrogen, Total Kjeldahl as N ZSoXCobalt 69. Pesticides/PCB’s 13. Solids, Percent (%) 32. Oil and Grease 51. Copper 70. Disk Deliverables 14, Solids, Settleable 33. Phenol 52. Iron TCLP 15. Solids. Suspended 34. Phosphorus. Total as P 53, ^ead 71. TCLP-Metals 16. Solids. Total 35. Phosphorus, Ortho as P Magnesium 72. TCLP-Pesticides 17. Solids. Total Dissolved 36. Sulfates /55.’ ^anganese 73. TCLP-Herbicides 1& Solids, Total Volatile 37. Surfactants I 56. Mercury 74. TCLP-Volatiles (JpOther; 38. IIV254 1-57.1 ^Molybdenum 75. TCLP-BNA's 58/Nickel

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