Chain of custody record with sampling details, Westchester County

NYC 9/11 Public Portal Document

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM

HL lUactchMter County

Time/Date Set;_________ 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) Sample Type (circle one); 1. Potable 3. Non-Potable Treated Bottle #'s:. p 1212 KI 2. Non-Potable 4. Other________ _ Chain of Custody? .yes no Time/Date Collected; h bl-If I Agency Code;/V;' fV Comments; Collected By; t ' PWS #;_________ Source ID;, .Type Descriptor;. Collected From; Bill to; Location’s/lndividual’s Name. I !< * V- I 6 V I k Name/Company Street__________________ Street__________ City/St/Zip_______________ City/St/Zip Identification of Source Phone#;_ _______ Fax #;. Collection Point_^^_^^,^.^^ r .U-/ Il I Kt / IC' I I CA, CH. Bl? Check#; Amounts

BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLE/SOLID ANALYSES Lab#;______________________ Lab #; (circle tests) (circle 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) 3. Coliform MPN (priv well, ratw, stp) 4. Total Trihalomethane Potential (510) 4, Phthalates (606/8060) 4. Fecal Coliform (all samples) 5. Microextractables (504) 5. Organpchlorine 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) 7. API 8. PCB as Decachlorobiphenyl (508A) 8. Other Pesticides (SM-18/6630) 8. Other;, 0? 9. Herbicides (515) 10. Pesticides (525) 9. Petroleum Hydrocarbon Scan (310-13)p 10. Glycols in Water , Refrigerated? yes .no 11. Carbamate Pesticides (531) 11 Acid Extractables (625/8270) 12. Glyphosate (547) 12^ase Neutral Extractables (625/8270) Chionnated?; .yes. no 13. Diquat (549) , . As^C/MS Unknown Scan l4. Chlorination Disinfection Byproducts (551) 14/ Purgeable Halocarbons (DEF) Free Chlorine Res;. ■ 15. Haloacetic Acids (552) 2 15; Purgeable Aroniatics (DEF) ? - J e.'Other Pesticides (SM-18/66,30) .16. Pesticides (DEF) ■ ' Total Chlorine Res; ImgZj^. .i17. Petroleum/Hydrocarbon Scan (310-13) .17. PCB's (Arochlors) (DEF)-

pH t. i INORGANIC ANALYSES REQUI teb#; (circle tests) 1. .Color 39. Aluminum 59. Potassi 2. Turbidity CaCOa 40. Antimony 60. Selenium*! 3. pH ■ Bromide 41. Arsenic 61. Silver I 4. Conductivity Bmmate/Chlorate/Chlorite 42. Barium ‘ 62. Sodium 9 5. Corrosivity (temp; ’C) W;c^oride 43. Beryllium 63. Thallium 6. BOD (5 day) 44. Boron 64. Vanadium 7. Soluble BOD (5 day) ^26\ FItibride 45. Cadmium 65, Zinc 8. Carbonaceous BOD (5 day) 27. Hardness, Total as CaCOa 46. Calcium, as CaCOs 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 19. Other;_______________ 38. IIV254 57. Molybdenum 75. TCLP-BNA's SSJ'Jickel

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