Chain of custody record, Westchester County Lab, Nov 2001

NYC 9/11 Public Portal Document

in ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM h' WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 Ulettsbestsr County (914)593-5575 . '"i ' . - NYS-ELAP No. 10108 . ime/Date Set; FormA-70 (rev. 1/96) ^mple Type (circle one): 1,/Potable 3, Non-Potable Treated Bottle-#’s; ....... > £ Non-Potable 4, Other _____________ _________ Chain of Custody? .yes .no Time/Date Collected: __________ Comments; Collected By: N'" WaM*’* Agency Code: PWS #;_________ ;Source ID: Type Descriptor, *' • Collected From; / Bill to: Location's/lndividual’s Name i z -/KO Name/Company Street 1 ^6/________________ Street___________ City/St/Zip /OT^O____________ City/St/Zip Identification of Source_________________________________ Phone#: _______ Fax #:_____________ Collection Point 0 I CA, CH, Bl? Check#;Amounts.

BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLE/SOLID ANALYSES Lab#;______________________ Lab #;_______________________ (circle tests) (circle lesls) 1. Heterotrophic Plate 1 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 (priy, 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) ' API ■ 8. PCB as Decachlorobiphenyl (508A) 8. Other Pesticides (SM-18/6630) /. Other; _______________ 9. Herbicides (515) 9. Petroleum Hydrocarbon Scan (310-13).? 10. Pesticides (525) 10. Glycols in Water;' . „ Refrigerated? yes no 11. Carbamate Pesticides (531) 11. Acid Extractables (625/8270) J 12. Glyphosate (547) 12. Base Neutral Extractables (625/8270)^5 Chlorinated?; yes no ’13. Diquat (549) @GC/MS Unknown Scan ' 14. Chlorination Disinfection Byproducts (551) 14. Purgeable Halocarbons (DEF) Free Chlorine Res; mg/L 15. Haloacetic Acids (552) 15. Purgeable Aromatics (DEF) 16. Other Pesticides (SM-18/6630) 16. Pesticides (DEF) Total Chlorine Res; mg/L- 17. Petroleum/Hydrocarbon Scan (310-13) 17. PCB's (Arochlors) (DEF)

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INORGANIC ANALYSES REQUESTED - Lab#;. (circle tests) 1. Color 20. Acidity .. 39.,^AIuminum 59. Potassiurh 2. T urbidity 21. Alkalinity, as CaCOs /'40.,'Antimony 60. Selenium': 3. pH 22. Bromide 41. Arsenic 61. Silver ! 4. Conductivity 23. Bromate/Chlorate/Chlorite Jt2. Barium 62. Sodium ■ 5. Corrosivity (temp; .’C) 24. Chloride Beryllium (J'3?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 CaCOs 46. Calcium, as CaCOs 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 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 5,1-^Copper 70. Disk Deliverables ! 4. Solids, Settleable 33. Phenol <52.4ron ICLP ■ 15. Solids, Suspended 34. Phosphorus, Total as P 53.' Lead 71.TCLP-Metals 16. Solids, Total 35. Phosphorus, Ortho as P S^Magnesium 72. fCLP-Pesticides 17, Solids, Total Dissolved 36. Sulfates (^^..<Manganese 73. fCLP-Herbicides l^_^olids, Tot^Volatile 37. Surfactants Mercury 74. TCLP-Volatiles • '59,.dther: 38. IIV254 ^y.'Molybdenum 75.TCLP-BNA's ^'58. Nickel -■ fe

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