Chain of custody record, Westchester County Labs

NYC 9/11 Public Portal Document

in UteksheMar County

Time/Date Set:_________ ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES ANO 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): ,1. Pota^ 3. Non-Potable Treated Bottle #‘s: ? A / ‘ 2? Non-Potable 4. Other____________________________ Chain of Custody? .yes no Time/Date Collected:. r-a Comments: Collected By: ______________ Agency Code: PWS #;_____________ Source ID:. Type Descriptor;. Collected From; 1/ ■ y 4 / 1^-4/ * ’4jame/Company. Location's/lndividual’s Name. Street__________________ Street_____ City/SVZip_______________ City/St/Zip Identification of Source Phone#:, ,Fax #:. Collection Point I CA, CH, Bl?. Check#; _ Amounts. 1__X_ BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLE/SOLID ANALYSES Lab#:■ Lab#: / (circle tests) (circle tests) ' 1, Heterotrophic Plate 1. 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 Pesticides (507) '6. PCB's (Arochlors) (608/8080) ■ :■ e-v

6. Macroscopic LS/ Pesticides/PCB screen (508) 7. Herbicides (SM-18/6640; 8151) 1 7. API 8. PCB as Decachlorobiphenyl (SOSA) 8. Other Pesticides (SM-18/6630) w 8. Other:___________________ Herbicides (515) 9. Petroleum Hydrocarbon Scan (310-13) t Pesticides (525) 10. Glycols in Water Refrigerated? .yes no Carbamate Pesticides (531) 11. Acid Extractables (625/8270) ’ 12. Glyphosate (547) I^Base Neutral Extractables (625/8270) Chlorinated'’: .yes no 13. Diquat (549) 14. Chlorination Disinfection Byproducts (551) ff^GC/MS Unknown Scan Purgeable Halocarbons (DEF) 3 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)

pH

INORGANIC ANALYSES REQUESTED ab#: £3 (circle tests) 1. Color 20. Acidity 39. Aluminum 59. Potassium 2. Turbidity Afealinity, 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 5 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 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. 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:_____________ 38.1.IV254 57. Molybdenum 75. TCLP-BNA’s 58. Nickel

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NYC-WTC_000071271