Chain of custody record, Westchester County Lab, Nov 2001

NYC 9/11 Public Portal Document

111 ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH 1

2 Dana Road, Valhalla, New York 10595 Uteitehostef County (914)593-5575 NYS-ELAP No. 10108 Time/Date Set:____________________________ Form A-70 (rev. 1/96)

Sample Type (circle one): Potable 3. Non-Potable Treated Bottle #’s; 2. Non-Potable 4. Other Chain of Custody? .yes no Time/Date Collected: Comments: Collected By: / Y' t Z' C-' 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. BP. Check#: Amounts, Collection Point.

BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLE/SOLID ANALYSES Lab#:_________________________ Lab #:________________________________ (circle tests) (circle tests) 1. Heterotrophic Plate l.^-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 .P.esticides/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) O-Besticides (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)

L£!±=™ INORGANIC ANALYSES REQUESTED - Lab# (circle tests) 1. Color .^0. Acidity /'Ss. Aluminum 59. Potassium 2. Turbidity .'^1. Alkalinity, as CaCOa / 401 Antimony Selenium 3. pP ■g2. Bromide j 41 Arsenic Silver 4. Conductivity 'S3. Bromate/Chlorate/Chlorite 1 42 Barium Sodium 5 Corrosivity (temp: .’C) ;§4. Chloride V 4^ Beryllium Thallium 6. BOD (5 day) -?5. Cyanide 44. Boron Vanadium 7. Soluble BOD (5 day) ^6. Fluoride 45. Cadmium __________ 8. Carbonaceous BOD (5 day) ?7. Hardness, Total as CaCOg 46. Calcium, as CaCOa 9. Chemical Oxygen Demand 28. Nitrogen, Ammonia as N 47. Calcium, Ca*^ eFfyietals/CN 10. Dissolved Oxygen 29. Nitrogen, Nitrate as N Chromium, Total 67. Volatiles 11. Total Organic Carbon 30. Nitrogen, Nitrite as N Chromium, Hexavalent 68. Semi-volatiles 12. Total Organic Halides 31. Nitrogen, Total Kieldahl as N ./SO, Cobalt 69. Pesticides/PCB's 13. Solids, Percent (%) 32. Oil and Grease / 51.1 Copper 70. Disk Deliverables I 52.1lron 14. Solids, Settleable 33. Phenol TCLP 15. Solids. Suspended 34. Phosphorus. Total as P \^Lead 71. TCLP-Metals 16. Solids, Total 35. Phosphorus, Ortho as P o4. Magnesium 72. TCLP-Pesticides 17. Solids, Total Dissolved 36. Sulfates /•55\ Manganese 73. TCLP-Herbicides 18. Solids. Total Volatile 37 Surfactants I 56.\Mercury 74. TCLP-Volatiles Other- 38. I. IV254 I 57. (Molybdenum 75. TCLP-BNA’s \ 58/Nickel

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