Chain of custody record, Westchester County Labs

NYC 9/11 Public Portal Document

III UiMlehattar County ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 (914) 593-5575 s NYS-<CAP No. 10108 )' 0

Time/Date Set: _____________________ z j^ofm A-70 (rev. 1/96) Sample Type (circle one): ,12. 1. Potable 3. Non-Potable Treated Bottle #’s: ■.-'''y ; « / - :I 2. Non-Potable 4. Other ______ _____________ Chain of Custody? .yes no Time/Date Collected: i / i: > / Comments: Collected By: । if Aaencv Code: PWS #:_________ Source ID:. Type Descriptor; Collected From; Bill to: Location’s/lndividual's Name ■(i < r- V, Name/Company Street________________ ___________________________ Street__________ City/St/Zip_________________________ 2_________ _ City/St/Zip______ Identification of Source______ ______________________ Phone#:_ -Fax#:. Collection Point. I CA, CH. Bl? Check#: Amount$

BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLE/SOLip ANALYSES Lab#:__________ ____________ Lab #:_________________ __________ (circle tests) (circle tests) 1. Heterotrophic Plate 1 Trihalomethanes (524) /VcJ 1. Purgeable Halocarbons (624/8260) Count (hemodialysis & aill others) 1^1 VulailWI Idlutdibanc (624)- V</C 2. Purgeable Aromatics (624/826Q) 2. Coliform P/A (public supplies) Volatile Afftrnnticn (524) ; , , 3. Acrolein & Acrylonitrile (624) 3. Coliform MPN (priv well, raw, stp) 4. Total Trihalomethane Potential (510) J, , / 4. Phthalates (606/8060) 4. Fecal Coliform (all samples) 5. Microextractables (504) ' ' 5. Organochlorine Pesticides (608/8080) 5. Microscopic Pesticides (507) 4 6. PCB's (Arochlors) (608/8080) 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;___________________ 9a. Herbicides (515) 9. Petroleum Hydrocarbon Scan (310-13) (5?. Pesticides (525) 10. Glycols in Water Refrigerated? .yes no 11. Carbamate Pesticides (531) 11. Acid Extractables (625/8270) 12. Glyphosate (547) ia Base Neutral Extractables (625/8270) Chlorinated?: yes no 13. Diquat (549) ^3/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)

pH---------- . ■ :r INORGANIC ANALYSES REQUEBTED ^Jab#:. (circle tests) 1. Color 20: Acidity 39. Aluminum 59. Potassium 2. Turbidity 2t Alkalinity, as CaCOs 40. Antimony 60. Selenium 3. pH 22. Bromide 41. Arsenic 61. Silver 4. Conductivity .23L Bcpmate/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 CaCOs 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 ISLP 15. Solids. Suspended 34. Phosphorus, Total as P 53, Lead 71.TCLP-Motals 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. I.IV254 57. Molybdenum 75. TCLP-BNA’s 58. Nickel

NYC-WTC_000071349