Chain of custody record, Westchester County Lab, Nov 2001

NYC 9/11 Public Portal Document

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM

III UlMtehecter County '• WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla. New York 10595- --{914)593-5575 NYS-ELAP No. 10108 Form A-70 (rev. 1/96) Time/Date Set: Sample Type (circle one): C 0^2 7 1. Potabl^ 3. Non-Potable Treated Bottle #’s; H /•

2. Non-Potable 4. Other______________ Chain of Custody? .y®s no Time/Date Collected:. O’’t/ ? Comments: Collected By: ‘'O’PlobgH Agency Code: PWS #;______________ Source ID; Type Descriptor:.

Collected From: -7/ Bill to; Location’s/lndividual’s Name__2^ 62 7d Name/Company Street_____________________________________ Street_______________ City/St/Zip_________________________________ City/St/Zip____________ Identification of Source_____________________ Phone#;_____________ .Fax #:_ Collection Point J? O rCA?CH7Bi?^^^Z Check#: Amounts.

BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLE/SOLID ANALYSES ■ Lab#;_________ _______________ Lab (ct,rcle tests) . - . .. (circle tests) ( / j 1Heterotrophic Plate Trihalomethanes (524) / 1, Purgeable Halocarbons (624/8260) 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); 1 4. Total Trihalomethane Potential (510) ' 4. Phthalates (606/8060) 4. Fecal Coliform (all samples). , ;. 5. Microextractables (504) 5. Organochlorine Pesticides (608/8080) 5. Microscopic Pesticides (507) 6. PCB's (Arochlors) (6O8/8O8O) * 6. Macroscopic Pesticides/PCB screen (508) 7. Herbicides (SM-18/6640; 8151) 8. PCB as Decachlorobiphenyl (508A) 8. Other Pesticides (SM-18/6630) 9. Petroleum Hydrocarbon Scan (310-13) /W Pesticides (525) .10. Glycols in Water ' Refrigerated? .yes.no ■ TK Carbamate Pesticides (531) 11. Acid Extractables,(625/8270) 12; Glyphosate (547) 12. Base Neutral Extractables (625/8270) (3^ GC/MS Unknown Scan- Chlorinated?; yes • no '13; Diquat (549) - 14. Chlorination Disinfection Byproducts (551) 14. Purgeable Halocarbons (DEF) Free Chlorine Res:^: Tng/I^ ■ 15. Haloacetic Acids (552) , 15. Purgeable Aromatics (DEF) I •16. Other Pesticides (SM-18/66'30)' 16. Pesticides (DEF)Y . Total Ch!orine^Res:’ii ”1.k Petroleum/Hydrocarbon Scan (310-13) 17. PCB’s (Arochlors)'(DEF) '

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INORGANIC ANALYSES REQUESTED - Lab#: (circle tests) 1. Color ./ 20, Acidity Aluminum 59. Potassium 2. Turbidity ,, 3. pH 4. Conductivity 4 21. Alkalinity, as CaCOa 22, Bromide. 23, Bromate/Chlorate/Chlorite lAntimony . .rsenic iBarium © Selenium Silver Sodium 5. Corrosivity (temp; .°C) 24: Chloride _ Beryllium Thallium 6. BOD (5 day) 7. Soluble BOD (5 day) 8. Carbonaceous BOD (5 day) 25, Cyanide , 26, Fluoride 27, Hardness, Total as CaCOa 44. Boron 45. Cadmium 46. Calcium, as CaCOa A I Vanadium Zinc lp 9. Chemical Oxygen Demand 28, Nitrogen, Ammonia as N 4Z 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 Cobalt 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, l^Lead 71. TCLP-Metals 16. Solids. Total 35, Phosphorus, Ortho as P ^4. Magnesium 72. TCLP-Pesticide s’ 17. Solids, Total Dissolved 36, Sulfates Manganese 73. TCLP-Herbicides 18. Solids. Total Volatile 37, Surfactants Mercury 74. TCLP-Volatiles Tg^Other: Sk__________ 38, IIV254 Molybdenum 75. TCLP-BNA's <58 Nickel

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