Chain of custody record, Westchester County Labs

NYC 9/11 Public Portal Document

SAS ENVIRONMENTALSERVICES SAMPLE SUBMISSIONFORM A - 5I te '•'3-J III ; Utesichester County WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 (914) 593-5575 . A r' W (... mA NYS-ELAP No. lOlpfi^.. Form A-70 (rev. 1/96) ■'■Yime/Date Set: ••j Sample Type (circle one): TUit2i*P’S«n’7,'?tfc2fc M. Potable^^ 3. Non-Potable Treafed Bottle ■^nMoivPotable 4. Other Chain of Custody? yes no ■4

Time/Date Collected:_ Comments._______________________ Collected By: ~ CCFTT^ Agency Code: PWS Source ID:Type Descriptor: Collected From: Bill to: Location’s/lndividual’s Name^ ■ Name/Company. street Street________ city/st/ziD ‘ City/St/Zip_____ Identification of Source____________________________ ■— Phone#:. . _Fax #: Collection Point, i j ■ I CA. CH, Bl? Check#: Amounts.

BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLE/SOLID ANALYSES ;Labilt:________ ____________ 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) f . .2; Coliform P/A (public supplies) Volatile Aromatics (524) 3. Acrolein & Acrylonitrile (624) . 3. Coliform MPN (priv well, raw, stp) Total Trihalomethane Potential (510) 4. Phthalates (606/8060) '/ I.'-' ■4, Fecal Coliform (all samples) 1 ’■ . 5. Microextractables (504) 5. Organochlorine Pesticides (608/8080) ;6.Microscopic 6\ Pesticides (507) 6. PCB’s (Arochlors) (608/8080) 6. Macroscopic , Pesticides/PCB screen (508) 7. Herbicides (SM-18/6640; 8151) I 7. API 6. PCB as Decachlorobiphenyl (508A) 8. Other Pesticides (SM-18/6630) Y - - 8. Other:_______ ■_________ ' Il Herbicides (515) 9. Petroleum Hydrocarbon Scan (310-13) . Pesticides (525) , 10. Glycols in Water _ - . Refrigerated?ves no ^11. Carbamate Pesticides (531) 11. Acid Extractables (625/8270) 42. Glyphosate (547) Base Neutral Extractables (625/8270) \Chlonnated?: .yes no 43. Diquat (549) 0. GC/MS Unknown Scan i ‘14; Chlorination Disinfection Byproducts (551) 14. Purgeable Halocarbons (DEF) Free Chlorine Res: _____ _m9ZL a 45. Haioacetic 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)

w- ri 4 INORGANIC ANALYSES REQUES^b Bab#: (eircletesfs) ----------------- 1. .Color 39. Aluminum ^^Potassium 2. Turbidity .,2.1/ ‘A>linity, as CaCOa (Antimony 60. Selenium 3, pH . /;^;3^mide 41. Arsenic j. 61 ..^Silver 4. Conductivity . 23. Bro’mate/Chlorate/Chlorite 42. Barium Cp2.''Sodium 5. Corrosivity (temp: .°C) £;:^ciilpride ^^^eryllium ^./Thallium ' 6. BOD (5 day) ■ ' Cyanide 44. Boron ''eZ^anadium 7- Soluble BOD (5 day) 'S26. Fluoride 45. Cadmium *^5. Zinc . 8. Carbonaceous BOD (5 day) , 27. Hardness. Total as CaCOa 46. Calcium, as CaCOa 9. I Chemical Oxygen Demand 28. Nitrogen, Ammonia’as N Calcium, Ca*^ 66. Metals/CN ^10, Dissolved Oxygen 29. Nitrogen. Nitrate as N ’' 48. Chromium. Totar 67. Volatiles /Il/'Total.Organic Carbon 30. Nitrogen. Nitrite as N / 49. Chromium. . Hexavalent 68. Semi-volatiles - j^12. Total Organic Halides i; , 31, Nitrogen. Total Kjeldahl as N (JO?Cobalt 69. Pesticides/PCB’s 13. Solids, Percent (%) , 32. Oil and Grease • . 51/Copper 70. Disk Deliverables |1< ;Splids. Settleabie // f 33. Phenol , (^^ron' ; - 15. Solids, Suspended : J 34/pi^ph6rus. Total as P 53. Lead _ ■ 71. TCLP-Metal8^^^^Y 'T6.;Sblids/Total ; ; " j 35; Phosphorus. Ortho as;P ^^^^agnesium / / 72.TCLP-Pesticides 17. Solids. Total Dissolved , 36. Sulfates ', CSS^anqanese 73"TCLF-Herbicides £^Sdiids. Total Volatile ' ■ 37. Surfactants * 56,.,Mercury 74.TCLP-Volatiles/ pother: ,-38.UV254 <TiXloIybdenum-. S 75<CLP-BNA's />

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