Chain of custody form, Westchester County Labs

NYC 9/11 Public Portal Document

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UI ENVIRdNMENtAtSERVICES ’SXMPLE'SUBMISSldN FORM > , “WESfCHEsfER COUNTY LABORATORIES'AND RESEARCH ' ' ’ 2’Dana’Roaa;Valha’ll>. New York 10595 '-Utertohester County *• ‘l •' : (9'1'4)59^5575' . ■ , NYS-ELAP No. 10108/ i- '-Time/Date Set: ~ ’ Form A-70 (rev. 1/96) - 'Sample Type (circle one): .P TS' / 7 i . 1. Potable 3. Non-Potable Treated Bottle #’s: ‘ 2. Non-Potable 4. Other________ ■ Chain'of Custody?' '?>- ves ' - - no * ' 4. •Tirne/Date Collected:' / / : Comments:'" .ri Collected Bv: |.. -■ Agency Code: . PWS #: • Source ID; Type Descriptor: Collected From: Bill to: -Location's/lndividuars Name. Name/Company. yC Street jj 5.! '"* Street_________ Df . LJ’----- — City/SVZip > iy-; . ;eS ?S'' City/St/Zip Identification of Source________ > •_______________ - Phone#: _Fax #:_ Collection Point. Z... -i ■ I CA, CH, Bl? Check#; Amounts

BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLE/SOLID ANALYSES

h Lab#: /(circle tests) ________________ L.

d. Heterotrophic Plate Lab #: (circle te^ts) 1^^ 1. Trihalomethanes (524r~'" I f I Z | Y/ 1. Purgeable Halocarbons.(624/8260) Count (hemodialysis & 'all others) Volatile Halocarbon's (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); Sp Total Trihajomefh’ar^^otentiai_(5'l 0) 4,' Phthalates (606/8060), " e-.s 4. Fecal Coliform (all samples)'' ' 5" Microextractables (504) s 5. Organoclildrine Pesticides'(608/8080)’ . t ■'5. Microscopic, 6. _Pesticides'(507)' 6. PCB's (Arochlors) (608/8080) 6. Macroscopic' ‘ ' 'f^esticjde's/PCB screen^(508)- 7? Herbicides,(SM-18/6640; 8151)t RGB.as,Decachlorobiphenyl (508A) 8. Other Pesticide's;(S^^^^^ j 7-'APi • Herbicidbs (515) 9?' •Petrql^'m .H/djocarb'on Scan (310-13) .s.t. 8..Other:. ______ - - , , ^esj^'ides (525j;, 10. Glycdls’in .W^er, ' * Refrigerated? yes i}o jTl/Carbamate Pesticides (531)' 11. Acid Extractablbs'(625/8270)' ^i2rGiyph'osafe'(547)'■ ' , IZ'Base NeutrafEi^factables_(625/8270) . / Chlorinated?:ves ■ ■ rib' ^/ Diquat (^9)7 " ' (T3^C/MS;:yhknpwn,Scan^ _ ' , ' J* r^Purgeabie.Halocarbon'^(DEF). ■■14. Chlofihation'Disinfection Byproducts (551) mg/L' 1'5. Halqac'etic Acids (552) 15. PurgeabtelAromaticsjDEE)^ .‘Free Chlorine Res: ■ 1,6..Other Pesticides (SM-1,8/6630) 16. Pesticides (DEF)' Total Chlorine Res: .mg/L ■ ,'17. Petroleum/Hydrocarbon Scan (310-13) 17.’ PCB’s (Arbchiors) (DEF) -

., k . u” I INORGANIC ANALYSES REQUESTED tLab#: ... ■ O (circletests) CS «.h3 1. Color T^^luminum : /^Potassium •2. Turbidity ;2l'. Alkalinity, as CaCOs TVOy’Aiitimony Selenium 3. pH V44< Arsenic . 61. Silver, 4.' Conductivity . '23..Bromate/Chlorate/Chlbrite; 42..Barium'' <§2j Sodium/ I ., ■ 5. Corrosivity (temp: .°C) "^^^cSldride Beryllium 763'..iThalliurr 3 25?C^anide‘ Wr^roQ " Vanadium, a - 6. ^BOD(5day) 7. Soluble BOD (5 day), 2^'Plu^ide. 45;-.Ca,dmium. 651 Zinc ‘ 3 ________ . 8. Carbonaceous BOD (5 day) ■ 27.‘HaridrieYs; T qtalJas'CaCOti 46.''C’alciu'm)_as CaCOs rcLPJ ’9. iCherriical Oxygen Demand, 28?;Nitrogen; Amrfipni§?aS N/" /47\“(?alcium;’ca;^'’ :6^i^^^cN^ 7l 0. Dissolved Oxygen. 29?’^;trd^ri.. Nitwtejas’ N f '>>W^rpmium’,’,Tptali > ,6^y^tilSd; 11 .- Tptal Organic Carbon’; . SO'.tNitrogen'-Ni'tfite'.as Nt AozChromium, Hexavalent:' ; 6^>SefnbyoiatHe8^ 12.-total Organic,Halides,. ■ ■ 31 ENitrngenf^t^^ll^eldahl ,as< ^O^dbbaltf ' - 6^'. Resticides/PCB's. 32tQjl.and Grease; .70': bisk'Deliverab'les 13.;Splids7Percent:(%), l4,Sojids\Settlbablk^ 33'>PRenoO 52?drep.; >TCLP ~ ' — ~ - 15. ‘SoJids.'^SuspendedJ, ■ ^'hospfi'orus. "Tolalia^P^ 53?^idl S/-1:'TCLf^-Metals' • 16^ S^ojfds.vTot^i > 35rPhosph'orus;pftlTo7as/R.. zCTy lOiagn'e si u mV (72n;CQpf^ticides^ 17. ,^cls; jdtal'DiSsblved? 361 Sulf atesi lJlanganese> '<73rr(3l’g--Herbicides3 ^lids; TotauV^atil^ 37.‘ S'urtactants) ''5^*Me'rcury> 74!TCL;P-VolatHes> 38> Ciya^Y Z^TyMblygdenuifti 75?.TCLP;BNA:sj yseyNickeiL, . L- — hr-1 -Wr.-vb..' .. .. . J. . j'.Jj/-. A-'y/j Si. .. .... .r< di/ 'Y/.jXc NYC-WTC_000071481