Chain of custody record, Westchester County Lab, Nov 2001

NYC 9/11 Public Portal Document

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORMrH? P

r 111 UJertchestof 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): '^Potable 3. Non-Potable Treated Bottle #’s: H (jZ-, ($933" / 2. Non-Potable 4. Other Chain of Custody? .yes no 5 Time/Date Collected: ।________ Comments:; L Collected By: L <■. b -' Agency Code: L’-J C. PWS #:__________ Source ID: Type Descriptor:.

Collected From: Bill to: I Location's/lndividual’s Name. Name/Company

Street_____________________ Street___________ City/St/Zip_________________ City/SVZip Identification of Source Phone#:_________ Fax #: I CA, CH, Bl? Check#: Amounts. Collection Point,

BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLE/SOLID ANALYSES Lab#:_______________________ _ Lab #:____ (circle tests) (circle tests) 1. Heterotrophic Plate 1. Trihalomel(thanes (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, 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) 7- API 8. PCB as Decachlorobiphenyl (508A) 8. Other Pesticides (SM-18/6630) 8. Other:__________ ;__________ 9. Herbicides (515) 9. Petroleurn Hydrocarbon Scan (310-13) 10. Pesticides (525) 10. GlycbTs in Water, \ ' Refrigerated? .yes no 11. Carbamate Pesticides (531) 11. Acid Extractables (625/8270) 12. Glyphosate (547) 12. Base Neutral.Extractables (625/8270) 13. Diquat (549) (^i3)GC/MS Unkn'own Scan Chlorinated'’: yes no 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) / Leh_ INORGANIC ANALYSES REQUESTED - Lab#: (circle tests) 1. Color 20. Acidity 39. Aluminum 59. Potassium 2. Turbidity 21. Alkalinity, as CaCOa 40. Antimony 60. Selenium 3. pH 22. Bromide 41. Arsenic 61. Silver 4. Conductivity 23. Bromate/Chlorate/Chlorite 42. Barium 62. Sodium 5. Corrosivity (temp: .’C) 24. Chloride 43. Beryllium 63. Thallium 6. BOD (5 day) 25. Cyanide 44. Boron 64. Vanadium 7. Soluble BOD (5 day) 26. Fluoride 45. Cadrhium 65. 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 48. Chromium, Total 67. Volatiles 11. Total Organic Carbon 30. Nitrogen. Nitrite as N 49. Chrorriium, Hexavalent 68. Semi-volatiles 12. Total Organic Halides 31. Nitrogen. Total Kjeldahl as NI 50. Cobalt ’69. Pesticidds/PCB's 13. Solids, Percent (%) 32. Oil and Grease 51;Copper 70. Disk Deliverables ■ 14. Solids) Settleable 33. Phenol 52. Iron TCLP 1.5. Solids, Suspended. , 34,''Phosphorus. Totaj as.P ■53. Lead.’ t , ' - 7,VJ^^:l)^tals, '16. Sciids,'Total ’ 35. Phos'phorus.’Ortho" as P 52 .■Magnesium, , ■ 72.'TCLF?-Pe'sticides ' 17/ Solids, fptbl Dissolved' • ‘36?Sulfates: ” - • ,55.-Marj'ganese’; 73/fCLF’-Herbicides 18.' Solid's.' T Ota I Volatile 37.* Surfactants; . 56.’:Me/curyy ’•MiTCLP-Volatiles, . 38; iiV253 '■ . 57.' Molybdenurn; r ■75.;TCLP-BNA’Si 5 L :S8?Nicl<«T'.'

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