Chain of custody record with sampling and analysis fields

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 II NYS-ELAP No. 10108 Time/Date Set:_________ Form A-70 (rev. 1/96) Sample Type (circle one): 1. Potable 3. Non-Potable Treated Bottle #’s:. P iiYT 2. Non-Potable 4. Other___________ Chain of Custody? yes no Time/Date Collected:. Comments: Collected By: mb Agency Code: PWS #:_________ Source ID: Type Descriptor: Collected From: Bill to: Location's/lndividual’s Name. Name/Company . Street___________ _ Street__________ City/SVZip_______________ City/SVZip Identification of Source Phone#:________ _______ Fax #:. Collection Point I CA, CH, Bl? Check#: Amounts

BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLE/SOLID ANALYSES Lab#:______________________ Lab #:____________ j (circle tests) (circle tests) 3 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) . 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 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) rt'AP! 8. PCB as Decachlorobiphenyl (508A) .8. Other Pesticides (SM-18/6630) '8. *Other: ■''.'i• 9. Herbicides (515) 9. Petroleum Hydrocarbon Scan (310-13) 10. Pesticides (525) • 10. Glycols in Water Refrigerated? .yes. no S, 11. Carbamate Pesticides (531) 11. Acid Extractables (625/8270) ' .12. Glyphosate (547) 12-Base Neutral Extractables (625/8270) LChjbrinated?: .yes. .no ,13. Diquat (549) <(^GC/MS Unknown Scan •.j! ■14. Chlorination Disinfection Byproducts (551) 14. Purgeable Halocarbons (DEF) Free Chlorine Res:. 15. Haloacetic Acids (552) .15. Purgeable Aromatics (DEF) 16. Other Pesticides (SM-18/6630) " ' 16. Pesticides (DEF) Total Chlorine Res:-, .mg/bj».. .17. Petroleum/Hydrocarbon Scan (310-13) ; 17. PCB’s (Arochlors) (DEF)

t INORGANIC ANALYSES REQUE^D;ftab#:___ZZ (drcie tests) < 1-. Color Aridity 39. Aluminum 59. Potassium • 2,. Turbidity ’^’^ji^A^linity. as CaCOs 40. Antimony 60. Selenium 3. ■; pH Bromide 41. Arsenic 61. Silver 4;.Conductivity £2^- - --------- *■ ’ Bromate/Chlorate/Chlorite 42. Barium 62. Sodium • 5.-‘ Corrosivity (temp: .°C) W, C^^ide 43. Beryllium 63. Thallium ' 6, BOD (5 day) ;,25; Cyanide 44. Boron 64. Vanadium '7.\ Soluble BOD (5 day) ' 26. Fluoride 45. Cadmium 65. Zinc__________ '8.’ Carbonaceous BOD (5 day) 27. Hardness, Total as CaCOa 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 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 53. Lead 71. TCLP-Metals ,16. .Solids, Total 35. Phosphorus, Ortho as P 54. Magnesium 72. TCLP-Pesticides ■17. Solids, Total Dissolved 36. Sulfates 55. Manganese 73. TCLP-Herbicides .18.\Solids, Total Volatile 37. Surfactants 56. Mercury 74. TCLP-Volatiles /1 i^Other:_________________ 38. IIV254 57. Molybdenum 75. TCLP-BNA’s 58. Nickel

Uinb NYC-WTC_b00070897