Chain of custody record with contact details, Westchester County

NYC 9/11 Public Portal Document r^-V-ve'

UI ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 UlwichMtar County (914) 593-5575 NYS-ELAP No. 10108 Time/Date Set; r f It’ ‘ ? C’ Form A-70 (rev. 1/96) Sample Type (circle one); J^otable 3. Non-Potable Treated Bonlefe 2. Non-Potable 4. Other z z Chain of Custody?yes ____no Time/Date Collected: Comments: Collected By?^« Agency Code: Source ID; PWS #;_______ Type Descriptor: Bill.to; Location’s/lndividual's Name 2% r Name/Company Street________ _ _____________________________________ Street________ City/SVZip___________________________________________ City/St/Zip Identification of Source_________________ Phone#:, Fax #; __________ '-a- Collection Point, 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 (62^/8260) ' ' 2. Coliform P/A (public supplies) 3. Volatile Aromatics (524) 3. Acrolein & Acrylonitrile (624) 3. Coliform MPN .fpriv well, raw, stp) 4. Total Trihalomethane Potential (510) 4. Phthalates (606/8060) ’3 4. Fecal Coliform (all samples) 5. Microextractables (504) 5. Organochlorine Pesticides (608/8080) ■ 5. Microscopic Pesticides (507) 6. PCB's (Arochlors) (608/8080) 6. Macroscopic 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;___________________ Herbicides (515) 9. Petroleurn Hydrocarbon Scan (310-13)

Refrigerated? yes no § Pesticides (525) Carbamate Pesticides (531) 12. Glyphosate (547) 10. Glycols in Water 11. Acid Extractables (625/8270) " 1Z Base Neutral Extractables (625/8270) .' j Chlorinated?;yes. no 13. Diquat (549) Oi/GC/MS'Unknown Scan ’ 14. Chlorination Disinfection Byproducts (551) 14. Purgeable Halocarbons (DEF) Free Chlorine Res:. .mg/L 15. Haloacetic Acids (552) 15. Purge^ble Aromatics (DEF) 16. Other Pesticides (SM-18/6630) 16. Pesticides (DEF) Total Chlorine Res': mg/L 17. Petroleu m/Hydrocarbon Scan (310-13) 17. PCB’s (Arochlors) (DEF) / pH,,, ■ , - «- INORGANIC ANALYSES REQUESTED - Lab#: I wj; (circle tests) 1. Color 20. Acidity 39? ^luminum 59. Potassium; 2. Turbidity 21. Alkalinity, as CaCOa 40. Untimony |Selenium j /' 3. pH 22. Bromide 41. Arsenic Silver ‘ V /X. 4. Conductivity 23. Bromate/Chlorate/Chlorite 42. Barium Sodium 5. Corrosivity (temp: .’C) 24. Chloride 43/ Beryllium Thallium ; 6. BOD (5 day) '25. Cyanide 44. Boron 64. Vanadium'' 7. Soluble BOD (5 day) 26. Fluoride 45. Cadmium f^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 /^Chromium, Total 67. Volatiles 11. Total Organic Carbon 30. Nitrogen, Nitrite as N Jg. Chromium, Hexavalent 68. Semi-volatiles 12. Total Organic Halides 31. Nitrogen, Total Kjeldahl as N /^O^obalt 69. Pesticides/PCB’s 13. Solids, Percent (%) 32. Oil and Grease I 51. Copper 70. Disk Deliverables 14. Solids, Settleable 33. Phenol 52./lron TCLP 15. Solids, Suspended 34. Phosphorus. Total as P k^Lead 71. TCLP-Metals 16. Solids, Total 35. Phosphorus, Ortho as P 54. Magnesium 72. TCLP-Pesticides 17. Solids, Total Dissolved 36. Sulfates /6?Y^anganese 73. TCLP-Herbicides 18. Solids. TotalVolatile 37. Surfactants 156. Mercury 74. TCLP-Volatiles Other: SK 38. UV254 157.Molybdenum 75. TCLP-BNA's WNickel -■___________ V,. £ NYC-WTC_000070983