Chain of custody record, Westchester County Lab, Nov 2001

NYC 9/11 Public Portal Document

f ' I / • / ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM

IIL Utatteheiter 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): 7. 1 Potable 3. Non-Potable Treated Bottle #’s: 2. Non-Potable 4. Other Chain of Custody? yes no Time/Date Collected:_________________ Comments: Collected By: ■ Agency Code: PWS #:__________ Source ID: Type Descriptor:

Collected From: Bill to: Location's/lndividual's Name. Name/Company Street____________________ Street_______ ____ City/St/Zip________________ City/St/Zip 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 V 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 (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. Petroleum Hydrocarbon Scan (310-13) 10/'Pesticides (525) 10. Glycols in Water Refrigerated? .yes. no 11. Carbamate Pesticides (531) 11. Acid Extractables (625/8270) 12. Glyphosate (547) 12. Base Neutral Extractables (625/8270) Chlorinated?: yes no 13. Diquat (549) 13.-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)

dH

INORGANIC ANALYSES REQUESTED - Lab#: (circle tests) 1. Color Acidity Aluminum 59. Potassium ■ 2. Turbidity Alkalinity, as CaCOs / 40.lAntimony /60\Selenium 3. pH 52. Bromide j 41.lArsenic \^Silver 4. Conductivity -53. Bromate/Chlorate/Chlorite I 42.jBarium 62. Sodium 5 Corrosivity (temp: .°C) 24. Chloride 'Mj/Beryllium Thallium 6. BOD (5 day) Cyanide 44. Boron Vanadium 7. Soluble BOD (5 day) Fluoride 45. Cadmium •f^Zinc __________ 8. Carbonaceous BOD (5 day) 2-7. Hardness, Total as CaCOg 46. Calcium, as CaCOs tLP 9. Chemical Oxygen Demand 26. Nitrogen, Ammonia as N ^7,, Calcium, Ca*^ 66. Metals/CN 10. Dissolved Oxygen 29. Nitrogen, Nitrate as N ■ (4^ Chromium, Total 67. Volatiles 11. Total Organic Carbon 30. Nitrogen, Nitrite as N 49. _____ Chromium, Hexavalent 68. Semi-volatiles 12. Total Organic Halides 31. Nitrogen, Total Kjeldahl as N Cobalt 69. Pesticides/PCB’s 13. Solids, Percent (%) 32. Oil and Grease 51.|Copper 70. Disk Deliverables 33 Phenol 52.)lron 14. Solids, Settleable ICLP 15. Solids. Suspended 34. Phosphorus. Total as P \5^^ Lead 71. TCLP-Metals 16. Solids, Total 35. Phosphorus, Ortho as P 54 Magnesium 72. TCLP-Pesticides 17. Solids, Total Dissolved 36. Sulfates .■^^slManganese 73. TCLP-Herbicides Solids. Tot^Volatile 37 Surfactants I 56.|Mercury 74. TCLP-Volatiles •Other- 38. I. IV254 I 57./Molybdenum 75. TCLP-BNA’s t 58''Nickel

NYC-WTC_000071046