Chain of custody record with contact details, Westchester County

NYC 9/11 Public Portal Document

HL ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 IJU*rtch»««er County (914)593-5575 NYS-ELAP No. 10108 Time/Date Set: e - Form A-70 (rev. 1/96) Sample Type (circle one): © a Potable 3. Non-Potable Treated Bottle j J Hj ;i 2. Non-Potable 4. Other____________________________ Chain of Custody?yes ho Time/Date Collected: ff-2 '' 0/ Comments: Collected Bv: CAtOCode: PWS #:_______ .Source ID: Type Descriptor:. Collected From: > ✓ BUI to: Location’s/lndividual’s Name. Name/Co'mpany 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 ' ■ ■ J Lab#: Lab’#:L___^_=r.L_::;^__L____J^ - ' (circle tests) 1 (drcleie^s)j ’. • J 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) ’it# 3. Coliform MPN (priv/well, jaw, stp) 4. Total Trihalomethane Potential (510) 4. Phthalates (606/8060) ’ r- 4. Fecal Coliform (alh^amples) 5. Microextractables (504) 5. Organochlorine Pesticides (608/8080) 5. Microscopic 6 Pesticides (507) ’ 6. PCB's (Arochlors) (608/8080) 6. Macroscopic ' Pesticides/PCB screen (508) . J. Herbicides (SM-18/6640:'8151) 7. API 8.' PCB as Decachlorobiphenyl (508A) . . ’ 8. Other Pesticides (SM-18/6630) 8. Other: t 9_^Herbicides (515) . 9. Petroleum Hydrocarbon Scan (310-13) (^l^esticides (525) ' 10. Glycols in Water •Y Refrigerated? .yes. no .7 11. Carbamate Pesticides (531) .. 11. Acid Extractables (625/8270) 12. Glyphosate (547) * Igj^ase Neutral Extractables (625/8270) Chlorinated?: .yes no 7 43. Diquat (’549) ■ ■ Q3^C/MS Unknown Scan •■\4. Chlorination Disinfection Byproducts (551) 14. Purgeable Halocarbonis (DEF) Free Chlorine Res: .mg/L ' T5. Haloacetic Acids (552) 15. Purgeable Aromatics (DEF) 16. Other Pesticides (SM-18/6630) . 16. Pesticides (DEF) Total Chlorine Res: S41-7. Petroleum/Hydrocarbon Scan (310-13) 17. PCB’s (Arochlors) (DEF)

^•r i INORGANIC ANALYSES REQUeOd <^t#: (circle teats) 1. Color .luminum 5^ Potassium : 2. Turbidity , as CaCOa 40.Wntimony e^Selenium 3. pH ■,2'S'Brpmide 41. Arsenic ■fiJfSilver J 4. Conductivity 2^Br^ate/Chlorate/Chlorite 42. Barium ^^rSodium 5. Corrosivity (temp: .’C) 2'^iCtferide 42>^eryllium fj^Thallium 6. BOD (5 day) ■ iMMnide 44. Boron ^4. Vanadium 7. Soluble BOD (5 day) -SgrPIUdride 45. Cadmium <65?^inc 8. Carbonaceous BOD (5 day) 27. Hardness, Total as CaCOa 46. Calcium, as CaCOa 9. Chemical Oxygen Demand 28. Nitrogen, Ammonia as N 47. Calcium, Ca*^-- 66. Metals/CN 10. Dissolved Oxygen 29. Nitrogen, Nitrate as N ^^S^hromium, 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 'SO^obalt 69. Pesticides/PCB’s 13. Solids, Percent (%) 32. Oil and Grease 51. Copper 70. Disk Deliverables 14. Solids. Settleable 33. Phenol 52. ion ICLP 15. Solids. Suspended 34. Phosphorus. Total as P SsVead 71. TCLP-Metals 16. Solids, Total 35. Phosphorus, Ortho as P Tt^agnesium 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'j Other: n 38. IIV254 57. Molybdenum 58./Jickel 75. TCLP-BNA’s

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