Chain of custody record with sampling details, Westchester County

NYC 9/11 Public Portal Document

NL Utortchofter County ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road. Valhalla, New York 10595 (914) 593-55^^ _ 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 ifs: ~ < '2 O S -

2. Non-Potable 4. Other Chain of Custody? yes no Time/Date Collected: I Ct' - O f Comments; Collected By: / LA 0 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 . -O I CA, CH, Bl?_ Check#: Amounts

BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLE/SOLID ANALYSES Lab#:______________________ Lab #:______ C <7 / A (circle tests) (circle tests) ’ .'1 Q V-Y 1. Heterotrophic Plate i'^alomethanes (524) 1. Purgeable Halocarbons (624/8260) Count (hemodialysis & all others) a^olatile Halocarbons (524) 2. Purgeable Aromatics (624/8260) 2. Cdliform P/A (public supplies) sAl^olatile 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 ^^^^sticides (507) 6. PCB’s (Arochlors) (608/8080) _ i ■. 6. Macroscopic 7,/r^sticides/PCB screen (508) 7. Herbicides (SM-f8/6640; 8151) , V >. AP; K PCB as Decachlorobiphehyl (508A) 8. Other Pesticides (SM-18/6630) \ 8. Other;___________________ herbicides (515) 9. Petroleum Hydrocarbon Scan (316-13) ’esticides (525) 10. Glycols in Water -,’ , ' Refrigerated? .yes no 11. Carbamate Pesticides (531) ■ II.AcidExtractables (625/8270/ , 'o 12. Glyphosate (547) l^ase Neutral Extractables (625/8270)’ i Chlorinated?; yes no 13. Diquat (549). ^3^C/MS Unknown Scan 14. Chlorination Disinfection Byproducts (551) 14. Purgeable Halocarbons (DEF) Free Chlorine Res:. mg/L 15. Haloacetic Acids (552) . < ' 15.PurgeableAromatics(DEF)' 16. Other Pesticides (SM-18/6630j ■ J 3 6. Pesticides (DEF)’t ■ Total Chlorine Res; mg/L 17. Petroleum/Hydrocarbon Scan (310-13) . 17. PCB's (Arochlors), (DEF) ’ •'.A ■ ■■

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INORGANIC ANALYSES REQUESTED - Lab#:. (circle tests) fpl»^ a* 1. Color 20. Acidity /39.|Muminum 5,9. Potass jm 2. Turbidity 21. Alkalinity, as CaCOs / 40. Antimony / 60?Selenii m 3. pH I 22. Bromide ; 41. Arsenic VgX^iiver | 4. Conductivity 23. Bromate/Chlorate/Ch'lorite . 42. Barium 62. Sddiuni 5. Corrosivity (temp:__ .’C) 24. Chloride LAS^eryllium (^pThallium 6. BOD (5 day) ' 25. Cyanide 44 Boron 64 Vanadium 7. Soluble BOD (5 day) 26. Fluoride 45. Cadmium <653Zinc 8. Carbonaceous BOD (5 day) 27. Hardness, Total as CaCOs 46. Calcium, as CaCOg 9. Chemical Oxygen Demand 28. Nitrogen, Ammonia as N 47. Calcium, Ca*^ 66. Metals/CN 10. Dissolved Oxygen 29. Nitrogen, Nitrate as N ^^phromium. Total 67. Volatiles 11. Total Organic Carbon 30. Nitrogen, Nitrite as N 4S^Chromium, Hexavalent 68. Semi-volatiles 12. Total Organic Halides 31. Nitrogen, Total Kjeldahl as N ^BjCobalt 69. Pesticides/PCB’s 13. Solids, Percent (%) 32. Oil and Grease '51. Copper 70. Disk Deliverables 14. Solids, Settleable 33. Phenol 52. l/on IGLE 15. Solids, Suspended 34. Phosphorus. Total as P \5^ead 71. TCLP-Metals 16. Solids, Total 35. Phosphorus, Ortho as P S^Magnesium 72. TCLP-Pesticides 17. Solids, Total Dissolved 36. Sulfates ^5. Manganese 73. TCLP-Herbicides 1__8, Solids. TotaJ.yolatile 37. Surfactants I 56. Mercury 74. TCLP-Volatiles ^^^ther: o _________ 38. IIV254 1 57. Molybdenum 75. TCLP-BNA’s '■58. Nickel

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