Chain of custody record, Westchester County Lab, Nov 2001

NYC 9/11 Public Portal Document

ENVIRONMENTAL SERVICES SAMPLElSOEMISSIOr^FORMV WESTCHESTER COUNTY LABORATORIES AND RESEARCH ' 2 Dana Road, Valhalla, New York 10595 (914) 593-5575 NYS-ELAP No. 10108 "*^016/0316 Set: Form A-70 (rev.1/96)

SampJeType (circle one): -'“iTpotable"'""^ 3. Non Potable Treated Bottle#’s: < 2. Non Potable 4. Other Chain of Custody?yes no p' 3^ Time/Date Collected: / Z? 7/. i:?! / - O / Comments: Collected By: 0 ■ S6- Agency Code: PWS #: _ ____ Source ID: Type Descriptor: Collected From: Bill to: Location’s/lndividual’s Name Name/Company Street Street_______ City/st/zip -Ks p-.A <- H A i. r A- //y .-''^.'.5'"' City/St/Zip Identification of Source______________________________ Phone#: Fax#: Collection Point______ /' r) _______________ CA.CH, Bl? Check#: Amounts.

BACTERIOLOGICAL ANALYSIS ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLID ANALYSIS Lab#:_______________________ Lab#:________________________ (circle tests) (circle tests) 1. Heterotrophic Plate 1. Trihalomethanes (524) 1. Purgeable Halocarbons (624/8260) Count (hemodialysis & all others) ^Wolatile Halocarbons (524) 2. Purgeable Aromatics (624/8260) 2. Coliform P/A (public supplies) Wvolatile Aromatics (524) 3. Acrolein & Acrylonitrile (624) 3. Coliform MPN (privwell, raw, stp) 4. Total Trihalomethane Potential (510) 4. Phthalates (625/8270) 4. Fecal Coliform (all samples) 5. Microextractables (504) 5. Organochlorine Pesticides (608/8081) 5. Microscopic ^Pesticides (507) 6. PCB’s (Arochlors) (608/8081)' 6. Macroscopic Pesticides/PCB screen (508) 7. Methoprene (616) 7. API /^PCB as Decachlorobiphenyl (508A) 8. Herbicides (EPAI 978/8151) 8. Other:____________________ 9. Herbicides (515) 9. Pesticides (SMI 8/6630) 'f^tC^ticides (525) f 10. Petroleum Hydrocarbon Scan (310-13) Refrigerated? yes no ' tn. Carbamate Pesticides (531) 11. Glycols Chlorinated:? yes no 12. Glyphosate (547) - 12. Acid Extractables (625/8270) 13. Diquat (549) 13. Base Neutral Extractables (625/8270) Free Chlorine Res:. mg/L 14. Chlorination Disinfection Byproducts (551) {J^)3C/MS Semivolatile Unknown Scan 15. Haloacetic Acids (552) ’ iSf^Purgeable Halocarbons (DEF) Total Chlorine Res: mg/L 16. Pesticides (SM18/6630) 16. Purgeable Aromatics (DEF) pH 17. Petroleum/Hydrocarbon Scan (310-13) 17. Pesticides/PCB’s (DEF) 18. Other: 18. Other:

I . INORGANIC ANALYSIS REQUESTED - Lab#: / 's (circle tests) 1. Color 20. Acidity 39. Aluminum 59. Potassium 2. Turbidity 21. Alkalinity, as CaCOa '"40. Antimony 60. Selenium 22. Bromide '**41“ Arsenic 61. Silver . 3- pH ,4. Conductivity 23. Bromate/Chlorate/Chlorite 42. Barium .egi^odium 5. Corrosivity (temp:. .=C) 24. Chloride .43. Beryllium ^63^hallium 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 CaCOa 46. Calcium, as CaCOs ekP? ■ 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-violatiles 12.\Total Organic Halides 31; Nitrogen, Total Kjeldahl as N (507Gobalt 69.PesticidU/PCB’s 13. Solids, Percent (%) 32.><^ an Orease, Sl.^Copper 70. Disk Deliverables 14. Solids, Settleable 'a^pRenor) '52 jronj , 34>et?ospjioru_s7Total as.P/ 53^Xead} TCLP ‘15. Solids,-Suspended., <71.TCLP-Mefals 16. Solids, .Total., - ' 35: ghosf^Kprus/ drtRo;as p> 54. Magnesium''' 36'? Sulfates, ,/5^;iyi'anganese ’ , 72'. TCLP-Pesticides ‘ 17*' Solids, Total Dissolved; * 37'. Surfactants}. *56.^ercuiY: -73.TCLP-Herbicides , 1^.Splids,’'Tpta[,Volatilej ’ !74.'TCLP-Volatiles7 ■/TO/^Pther:-- — 381UV25?45“'' '■ i;57.Mofy^um j75;fCl^-Br^s) i

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