Chain of custody record with contact details, Westchester County

NYC 9/11 Public Portal Document

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM ' r 55: HI w istshester County >ate Set: WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana RoM Valhalla, New York 10595 , (914)593-5575 S /

YYz^YS-EUKRNo. 10108 A-70 (rev. 1/9^4t

I' S^pleTvpe (circle one): . ■ Bonl.r.P PotableX 3. Non-Potabfe Treated . :2: Non-Potable' 4. Other ‘ // 7 Chain of Custody? yes uno / ; Z < •Time/Date Collected: Cj -f :' ■ - ■ < , /C6mments:/Y. ./fcollected By: l/'y • Agency Code: ' PPWS#: ■ - Source ID: Type Descriptor:. Collected From: : X Bill to: 'Lbcation's/lndividual’s Name - Name/Company. Street £4 , Street City/SV2ip__Sk£liXtjlX£^L_jSdilL2_J^ City/St/Zip Identification of Source ______ _ Phone#: Fax Collection Point Ct^ '7 I CA,CH. Bl? Check#: Amounts.

BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLE/SOLID ANALYSES •Lab#Li________-L_- ■ Lab /(clrcte tests) . ' (circle tests) /I . Heterotrophic Plate Trihalomethahes (524) 1. Purgeable Halocarbons (624/8260) , .Cpunt (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 (606/8Q60) ' '■ 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 . ;; (W Pesticides/PCB screen (508) 7. . Herbicides (SM-18/6640; 8151) y 8. PCB as Decachlorobiphenyl (508A) 8. Other Pesticides (SM-18/6630) _____ ...•• ^9- Herbicides (515) 9. Petroleum Hydrocarbon Scan (310-13) Pesticides (525) ' 10. Glycols in Water /Refrigerated? yes no j I' fTt. Carbamate Pesticides (531) 11. Acid Extractables (625/8270) *" 12. Glyphosate (547) I^Base Nej,Jtfal Extractables (625/8270) ' •Chlorinated?; yes no pl 3. Diquat (549) ,r Q^GC/M S Un known Scan ,- 714. Chlorination Disinfection Byproducts (551) ,14. Purgeable Halocarbons (DEF) : Free' Chlorine Res:. mg/L ■ : 15. Haloacetic Acids (552) 15. Purgeable Aromatics (DE F) Y Pl 6. Other Pesticides (SM-18/6630) ' 16. Pesticides (DEF) Total Chlorine Res: rmg/L'j- '7'437. Petroleum/Hydrocarbon Scan (310-13) 17. PCB’s (Arochlors) (DEF)

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S' INORGANIC ANALYSES REQUESt|D^b#:_____tZ (circle tests) -Si ■ 4. i Color < : :39. Aluminum (S^Potassium .'2. Turbidity Sii^^/y^linity/ es CaCOa (Antimony ' 60; Selenium ’a..'. pH Bromide Arsenic Silver 4.; Conductivity , . : Brdirote/Ch lorate/Chlbrite 4g. Barium 5. Corrosivity (temp: ^^^eryllium 6. BOD (5 day) Borori ■ . : Q^^anadium 7. .. Soluble BOD (5 day) S ■ 26;Fidpridej ..f 45. Cadmium 65. Zinc ^Carbonaceous BOD (5 day) 27, Hardriess, Total as CaCOa 46_Calcium, as CaCOa 9. i Qbemical O)^gen Demand . 28.;ISIitrogen,' ArTirnohia as N:/ ^^^alcium, Ca:^;- '?S 66. MetalsZCN ''l O.Dissolved Oxygen 29. Nitrogen, Nitrate as N S 48. Chromium, Total 67. Volatiles 11, Total Organic Carbon 30. Nitrogen, Nitrite as N 49. Chromium, Hexavalent^ 68. Semi-volatiles ST?*. ;l2i Total Organic Halides i*, ; 31. Nitrogen, Total Kjeldahl as N Cobalt 69. Pesticides/PCB's ■• : a ^^ohds. Percent (%) * 32. Oil and Grease ^Copper 70. bisk Deliverables W^olids, Settleable - 33, 33, Phenol Phenol - Iron Iron ICLP iTSolids. Suspended 34. Phosphorus. Total as P 53. Lead , 71- TCLP-Metals „ , , 16. Solids, Total , . 35 PhosphoruSrOrthoas P /§^>^agnesium 72. TCLP-Pesticides 17. Solids, Total Dissolved! 36, Sulfates. , 455/vlanganese . ' • ; 73.-TCLP-Herbicides ■ 18. Solids, Total Volatile''' 37 Surfactants ,, ^Mercury , - . , 14 Other: ; 38.4IV254 . fgTjMolybdenum ' , 75. TCLP-BNA's : - , ' 5-ZNickel , L ' S' , J. i, ,

NYC-WTC_000071245