Chain of custody record, Westchester County Labs

NYC 9/11 Public Portal Document

lU ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road. Valhalla, New York 10595 LUoitcheitar County (914) 593-5575 NYS-ELAP No. 10108 Time/Date Set:_________ ________ O - 3 . CM 3., ct L_______ Form A-70 (rev. 1/96) mple Typo (circle one): © z Mil t u, Milt ,‘^lv Ml 5 Potable 3. Non-Potable Treated Bottle #’8: W L . < Q-fM_____________ 2. Non-Potable 4. Other, Chain of Custody? .y®8 no Time/Date Collected^_____ Comments: Collected By: ’ Agency Code:. PWS #:________ .Source ID:. .Type Descriptor:. Collected From: Bill to: Location’s/lndividuars Name. Name/Company Street__________________ Street^^^ City/SVZip_______ _______ City/St/Zip____ __ Identification of Source “ tl|l Phone#:_ ._Fax#:. Collection Point. < tV >0 I CA, CH. Bl? Check#: Amounts,

BACTERIOLOGICAL ANALYSES ORGANfC POTABLE ANALYSES ORGANIC NONPOTABLE/SOLIO ANALYSES Lab#:__________ ' ■ Lab '. (circle tests) (circle tests) 1. Heterotrophic Plate 1. Trihalomethanes (524) . 1. Purgeable Halocarbons (624/8260) Count (hemodialysis & all others) 2. Coliform P/A (public supplies) 3. Coliform MPN (priv well, raw, stp) © Volatile Halocarbons (524) Volatile Aromatics (524) 4. Total Trihalomethane Potential (510) 2. Purgeable Aromatics (624/8260) 3. Acrolein & Acrylonitrile (624) 4. Phthalates (606/8060) 4. Fecal Coliform (all samples) 5. Microextractables (504) 5. Organochlorine Pesticides (608/8080) 5. Microscopic Pesticides (507) '6. PCB’S (Arochlors) (608/8080) r i 6. Macroscopic 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:___________________ Herbicides (515) 9. Petroleum Hydrocarbon Scan (310-13) I. Pesticides (525) 10. Glycols in Water Y Refrigerated? .yes. no 11. Carbamate Pesticides (531) 11, Acid Extractables (625/8270) 12. Glyphosate (547) Base Neutral Extractables (625/8270) ."•i Chlorinated?: .yes. no 13. Diquat (549) GC/MS Unknown Scan 14. Chlorination Disinfection Byproducts (551) 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)

INORGANIC ANALYSES REQUESTED - Lab#:. (circle tests) 7^ f 1. Color 20. Acidity 39. Aluminum 59. Potassidm 2. Turbidity 21. Alkalinity, as CaCOa 40. Antimony 60. Seleniurp 3. pH 22. Bromide 41. Arsenic 61. Silver j 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. Cadmium 65. Zinc 8. Carbonaceous BOD (5 day) 27. Hardness, Total as CaCOa 46. Calcium, as CaCOa £LP 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-volatiles 12. Total Organic Halides 31. Nitrogen, Total Kjeldahl as N 50. Cobalt 69. Pesticides/PCB’s 13. Solids, Percent (%) 32. Oil and Grease 51. Copper 70. Disk Deliverables 14. Solids, Settleable 33. Phenol 52. Iron ISLE 15. Solids. Suspended 34. Phosphorus, Total as P 53. Lead 71.TCLP-Metals 16. Solids, Total 35. Phosphorus, Ortho as P 54. Magnesium 72. TCLP-Pesticides 17. Solids, Total Dissolved 36. Sulfates 55. Manganese 73. TCLP-Herbicides 18. Solids. Total Volatile 37. Surfactants 56. Mercury 74. TCLP-Volatiles 19. Other:_____________ 38. IIV254 57. Molybdenum 75. TCLP-BNA’s 58. Nickel -

NYC-WTC_000071268