Chain of custody record, Westchester County Labs

NYC 9/11 Public Portal Document

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHeIt^ COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New.York 10595 V, (914)593-5575 C / NYSrEI>P No. ipi^ .Time/Date Set._________ '_______;______________ _ < "Form A-70 (rev..1/96) ■ ; Sample Type (circle one): Potable ■ ■' 3, Non-Potable Treafed ■ j 2 . Nprl-Potable,. Y 4, Othec:_Y;:_^<uj_:Ya-Y.2_^^ Chain of Custody? V^s <? no' ■? ' Time/Date _ C6mments: . Collected ByLW£Lj^l3£/L______£_Agency Code: ' _ PWS #:____ __ Source ID: Type Descriptor: Collected From: Bill to: Location’s/lndividu'ai's Name X'/VC: ; Name/Company. _ ' Street.____ __ .City/St/Zip Uo ^^7 ./ City/St/Zip ■ ■. Identification of Sou'rce_^_______j_^_^iL_____ Phone#: _Fax#: ’ ' ; CollectiPn Point? -1 '' / ' '/ ' . I CA, CH Bl?- Check#: Amounts

BACTERIOLOGICAL ANALYSES - ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLE/SOLID ANALYSES ’ ■ 'j . Lab ' (drCletes(s)j /i (circle tests) ;-1 < Heterotrophic Plate/’ 1.Trihalomethanes (524) 1. Purgeable Halocarbons (624/8260) Y ‘ Count’(hemodia!ysis & all others), ■ 2<Cplifofm P/A (public supplies); • ,3. Colifofrn MPN’ (priv Well, ray/, stpj Volatile Halocarbons (524) •. ^ Volatile Arornaticsj (524) 4. Total Trihaldmethane Potential (510) 2. Purgeable Aromatics (624/8260) 3. Acrolein & Acrylonitrile (624) 4, Phthalates (606/8060) w :4,F^cal;Conforrt(allsamples)Y '; 5; Microextractables (504) 5. Organochlorine Pesticides (608/8080) ; 5. Micrd^copic' . V/-, ; ; '' / ' ;. . Pesticides (507)/ . ; 6. PCB’s (Arochlors) (608/8080) . f / 6/Macroscopic'';‘ . Pesticidea/F’CB screen (508) 7. Herbicides (SM-18/6640;'8151) 7. API , , . . 8? PCB as Decachlorobiphenyl (508A) 8. Other Pesticides (SM-18/6630) ; 8, dtherL:i2.Y2Yj^Y^222^^ 9. Herbicides (515) ? 9. Petroleum Hydrocarbon Scan (310-13) *^' Pesticides (525) , 10. Glycols in WMr , : “ir. , Refrig^ratedt-ii yes no 11. Carbamate Pesticides (531) 11. Acid Extractables (625/8270) 12. Glyphosate (547) . 12; Base Neutral Extractables (625/8270) Chlorinated?: .- yes ho ; 13. pi.quat (549) GC/MS Unknown Scan ’ 14. Chlorination Disinfection Byproducts (551) Purgeable Halocarbons (DEF) Free Chlorine Res; mg/L 15. Hafoacetic 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)

£H_ !

INORGANIC ANALYSES REQUESTED - Lab#:. (circle tests) 3 1. Color 20. Acidity 39, Aluminum <_59/Potassium 2.- Turbidity 21. Alkalinity, as CaCOa (4g/ Antimony 50. Selenium ^5 3- pH 22. Bromide 41. Arsenic 61. Silver | 4. Conductivity 23. Bromate/Chlorate/Chlorite 42‘. Barium 62; Sodium 5. Corrosivity (temp: .°C) 24. Chloride ’^43jj Beryllium / 6^'. Thallium 1 6. BOD (5 day) 25. Cyanide 44^ Boron Vanadium 7. Soluble BOD (5 day) ' 26. Fluoride 45. Cadmium ' 65. Zinc ________ ."■'j 8? .Carbonaceous BOD (Rday) 27. Hardness. Total as CaCOa . 46. Calcium, as CaCOa CLP 9, Chemical Oxygen Dernand 28. Nitrogen. Ammonia as N Calcium, Ca*^ 66. Metals/CN ■5^

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 <5,0-Cobalt 69. Pesticides/PCB's 13; Solids, Percent (%) 32. Oil and Grease \ 51. Copper 70. Disk Deliverables .U. Solids. Settleable 33j.Phenor '^.*.lr6n TCLP 15; Solids,’Suspended 34. Phosphorus, Total as P ' 53/Lead 71.TCLP-Metals ’ .16? Solids. Total : : ' 35. Phosphorus, Ortho as P. . ^5^ Magnesium, .v. 72. TCLP-Pesticides ITj. Solids. Total Dissolved ■ 36; Sulfates , , (^Manganese ■ 73. TCLP-Herbicides . I3. Solids, Total Volatile) ,■ Y? 37/.. Surfactant^;/;:''Ui-;;/' /■; Y;/§0’;Mercury' =?-■;?'/ T4. TCLP-Volatiles pother 38/liy25< / Molybdenum ?75iTCLP-BNA’s YfY u/A'/YYi; J'/ f/V uS'.5-:'.»K>y;5 A? //■ 58? Nickel ■ ;

NYC-WTC_000071362