Chain of custody record, Westchester County Labs

NYC 9/11 Public Portal Document

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 (914)593-5575 . > NYS-ELAP No. 10108 Time/Date Set:_____________________ __ Form A-70 (rev. 1/96) Sample Type (circle one): 1. Potable 3. Non-Potable Treated Bottle #’8: • 2. Non-Potable 4. Other_________ Chain of Custody? .yes no Time/Date Collected:>• V -> Comments: Collected By: ‘ hiulC Agency Code; PWS #: Source ID;. Type Descriptor;. Collected From: BUI to: Location’s/lndividuars Name H iP W (j Jf Name/Company Street ______________________________________ _ Street_______ __ City/St/Zip_______________________________________ City/St/Zip Identification of Source_____________________________ Phone#: _Fax #:, Collection Point. I CA. CH. Bl? Check#:____ Amounts.

BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLE/SOLID ANALYSES Lab#:_______ _ Lab #:____________________________ (circle tests) (circle tests) . 1 1. Heterotrophic Plate Trihalomethanes (524) 1. Purgeable Halocarbons (624/8260) Count (hemodialysis & all others) jjOl-Atelattt644ateeafb©rts-^4) \ C C , i 2. Purgeable Aromatics (624/8260) llh* , Tf■ ’ CJfci 3. Acrolein & Acrylonitrile (624) 2. Coliform P/A (public supplies) 3. Coliform MPN (priv well, raw, sip) 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) 6. Macroscopic Pesticides/PCB screen (508) 7. Herbicides (SM-18/6640; 8151) . 7. AP! 8. PCB as Decachlorobiphenyl (SOSA) ' 8. Other Pesticides (SM-18/6630) , 8. Other;___________________ Herbicides (515) 9. Petroleum Hydrocarbon Scan (310-13)

Refrigerated? .yes. .no d I. Pesticides (525) 11. Carbamate Pesticides (531) 10. Glycols in Water 11. Acid Extractables (625/8270) 12. Glyphosate (547) Base Neutral Extractables (625/8270) Chlorinated?; .yes. .no 13. Diquat (549) 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)

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INORGANIC ANALYSES REQUESTED -^b#:. (circle tests) ' / >' 7 1. Color 20. Acidity 39. Aluminum 59. Potassium 2. Turbidity 27- Alkalinity, 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..Chforide 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 CaCOs 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 If

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 TCLP 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 f;n MirkAi

NYC-WTC_000071350