Chain of custody form, Westchester County Dept of Labs

NYC 9/11 Public Portal Document

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ENVIRONMENTAL ster WESTCHESTER COUN^'gA^^'ATO^IES^AN'nipE^^^ >1 (V.com 2 Dana N^York ^595^t/ • ■

r • Turie/Date Set: S^iple Type (circle one): _______________ r NYS-ELAP No. 10108, Form A-70 (rev. 1 /96)

Potable^ 3. Non Potable Treated ^B0tt,lef5:e ‘iWW k 35^0, S 3OG,----- '2. Non-potable 4. Other ■ __________________ :__ Chain of Custody? yes'"no ' ' Time/Date Collected: Comments: Collected By: ~~ •'Ifj;.. t / /x Ifi*-- Agency Code: • ' PWS#:______ Source ID: Type Descriptor: Collected From: Bill to: Location’s/lndividual’s Name Narpe/Company Street i'S j Street________ City/St/Zip tVcnu City/St/Zip Identification of Source Phone#: Fax#: Collection Point fe H CA.CH, Bl? Check#: Amounts

BACTERIOLOGICAL ANALYSIS ORGANIC POTABLE ANALYSIS ORGANIC NONPOTABLE/SOLID ANALYSIS Lab#: __________ Lab#:________________________ (circle tests) "iciicre testsj' V'**. i. Heterotrophic Plate I.-Trihalomethanes (524) ' v ;■?./ i .\Purgeable Halocarbons (624/8260) Count (hemodialysis & all others) Volatile Halocarbons (524) 2. Purgeable Aromatics (624/8260) 2. Coliform P/A (public supplies) \3/ Volatile Aromatics (524) 3, Acrolein & Acrylonitrile (624) , . ’ ■ 3. Coliform MPN (priv well, raw, stp) 4. Total Trihalomethane Potential (510) 4. Pt^halates (625/8270) 4.,Fecal Coliform (all samples) 5. Microextractables (504) 5. Organochlorine Pesticides, (608/8081) ■ Microscopic 6. Pesticides (507)' 6. PCfts (Arochlors) (608/8081) 6.' Macroscopic Pesticides/PCB screen (508) 7. Methoprene (616) - tn • 8. P.CBfas,Decachlorobiphenyl (508Aj 8. Herbicfeles'(EPA1978/8151) 'iZi ' 5.;, Herbicides ,(515) 9. Pesticides (SMI 8/6630) , ' .4 UO.', .Pesticides^ (525) 10. Petroleum Hydrocarbon Scan (BIOtIS)}^ Refrigerated? yes no 11. Carbamate Pesticides (531) •11; Glycols '.A Chlorinated:’ yes - no. 12.;Glyphosate (547) ■ 12. Acid Extractables (625/8270) • 13. Diquat (549) 13, Base Neutral Extractables (625/8270) Free Chlorine Res: - nig/L 14. Chlorination Disinfection Byproducts (551) Q4JGC/MS Semivolatile Unknown Scan total Chlorine Res: _ mg/L 15. Haloacetic Acids (552) w. Purgeable Halocarbons (DEF) S’* ’ 16. Pesticides (SMI 8/6630) 16. Purgeable Aromatics (DEF) pH 17. Petroleum/Hydrocarbon Scan (310-13) 17. Pesticides/PCB’s (DEF) 18. Other:__________________________ 18. etcher:

INORGANIC ANALYSIS REQUESTED - Lab#: ■ -7 i' . . (circle tests) / . tj' Cx ; / f ' 1.-Color' '20. Acidity , 39. Aluminum Potassium, 2. Turbidity 21. Alkalinity, as CaCOs Antimony Selenium I O - 3. pH 22. Bromide Arsenic 61 .Silver j CO '4. Conductivity 23. Bromate/Chlorate/Chlorite 42. Barium ZSg. Sodium K/ 5. Corrosivity (temp:®C) 24. Chloride /'^Beryllium j 63. Thallium 6. BOD (5 day) ,25. Cyanide ’■“44. Boron \ 64. Vanadium > 7. Soluble BOD (5 day) , 26. Fluoride . 45. Cadmium Zinc 5 8. Carbonaceous BOD (5 day) 27. Hardness, Total as CaCOs 46. Calcium, as CaCOs CLP Chemical Oxygen Demand 28. Nitrogen, Ammonia as N /^.Calcium, Ca*^ 66. Metals/CN5 29. Nitrogen, Nitrate as N '“^.Chromium, Total 10. Dissolved Oxygen 67. Volatiles A .11.' Total Organic Carbon 30. Nitrogeri, Nitrite as N 49. Chromium, Hexavalent 68. Senii-violatiles 12.^Total Organic Halides'‘ 31 . Nitrogen, Total Kjeldahl as N (^0. Cobalt 69. Pesticides/PCB’s . 13. Solids, Percent (%). * 32. Oil ’an Grease 51 . Copper 70. Disk Deliverables ^^^olids, Settleable^ . . 33. Phenol’S Iron .^Bsolids, Suspended': 34. Phosphorus Total as P '^3 . Lead , i'^^Sblids/Tota^ 35. Phosphorus, Ortho as P ' /"^Magnesium '•> > 7J TCLP-Metals. • 72.tcLi^f?e^ides ' 17^ Solids, Total Dissolved/ 36.' Sulf^tes U 5p'Manganese 37.-Surfactants . ''—56. Mercury. > 73.TCLP-Herbicides Ud- S6lids;‘Tbtal Volatile' ' ,74..frCLP;.Vplatiles. Ott^ ' ■ " -aB-tuyaW'" • -(^ Molybcienum-. ■ ’75ACLP-BNA'S’ „ 58.Nickel'.. , r

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