Chain of custody form, Westchester County Labs

NYC 9/11 Public Portal Document Wěstchester* goy.com F7T. ENVIRONMENTAL SERVICES SAMPLE SUBMIŞSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH 12 30 2 Dana Roạd, Valhalla, New Yörk 10595} .(914) 593-5575 e/Date Set." "Sample Type' (circle one): 1.Potable 3. Non Potablé Treated 2. Non Potable : .4. Otheri. i timerDate, Collecie d:" 11401 NYS-ELAP No.,10108 Form A-70 (rev.1/96) Collected From: Location's/Individual's Name esc :DP street!" l0Pst L'kr Drym City/St/Zip Wiltallr _i: 10 I0S30 Identification of Source Collection Point _ Nol 18 {9701 KMtri sc0b, Cxi4 Bонe #21. 704/2107 Q787,=137,2167 Chain of Custody? -yes—no: Comments: PWS #: Source ID: Type Descriptor: Bill to: Name/Company Street City/St/Zip Phone#: Fax#: CA,CH, BI? Check#: Amount$ BACTERIOLOGICAL ANALYSIS ORGANIC POTABLE ANALYSIS ORGANÍC NONPOTABLE/SOLID ANALYȘIŞ Lab#: .(circle tests) 1. Heterotrophic Plate Count. (hemodialysis & all others) 2. Colform P./A, (public supplies) 3."Coliform MPN (priv well, raw,"stp) 4. Fecal Coliform' (all samples) 5: Microscopic* acroscopic. 8: Other: Refrigerated? : -yes Chlorinated:? __ yes Free Chlorine Res: Total, Chlorine Res: pH •Lab#: (circle tests) ,1.- Trihalomethanes (524) Volatile Halocarbons (524) .Volatile Aromatics_(524) Sl Toiait rinacmole (s Poltenial (St0): .Microextractables (504) Pesticidés (507). : Pésticides/PCB screen (508) PCB as Decachlorobiphenÿl "(508A): Herbicides, (515), dino• no mg/L mg/L. Pesticides: (525), :11. Carbamate, Pesticides (531); 12. Glyphosaté? (547). ;13.Diquat (549) *94. Chlorination Disinfection Byproducts , (551) 15: Haloacetic Acids: (552) '16. Pesticides (SM18/6630) 17. Petroleum/Hydrocarbon Scan (310-13) • 18. Other:_ INORGANIC, ANALYSIS REQUESTED. - Lab#: (circle tests) 335 Color 20. Acidity 39. Aluminum 2. Turbidity 21: Alkalinity, as CaCO3 40yAntimony 3. рH 22 Bromide 41. Arsenic 4. Conductivity 23. Biomäte/Chlorate/Chlorite 42. Barium 5. Corrosivity, (temp:- °C) 24. Chloride 543: Beryllium .6. BOD,(5 day) 25. Cyanide: . 44. Boron Soluble BOD (5 day) 26. Fluoride; 45. Cadmium 8. Carbonaceous BOD (5 day). 27?Hardness, Totãl ậs CaCOз 46. Calcium, as CaCOa - 1o Chẩmicãl Oxygen Demand. 28."Nitrogen) Ammonia as N' 47: Călčiüm; Ca*? :Dissolved Oxygen' 29. Nitrogen, Nitrate as. Nº 48.Chromium, Total 11. /Total Orgänic Carbon, 30.?Nitrogên: Nitrite, as NA 491Chromium; Hexavalent '12Total Organic Halides" 311 Nitrogen, Total Kjéldahl 'a§ N: Co Cobalt, 1a Solids, Percent (%)? 32%0i|'an Grease: 51:Copper. Solids Settléable* 33:Phenols (52lion 15: Solids) Suspended; 34%PhosphorusiTotal as P. 16.,Solids,, Total] 35 Phosphorús: Ortho, as: P.> 54 Magneșium} 17 Solids, Total Dissolved: 36 Sulfates, [55 Manganese: 18 Solids, Total Volatile, 37: Sürtactänts. Lorothersn 38{ÜV254* $57 Möyödenùm i. Purgeable Halocarbons (624/8260) 2. Purgeable Aromatics (624/8260) 3. Acrolein & Acrylonitrile (624) 4: Phthalates (625/8270) 5., Organochlorine Pesticides (608/8081) 6: PCB's (Arochlors); (608/8081):. 7., Methoprene (616)) 8 Herbicides (EPA1978/8151); 9. PesticidesSM18/6630) 10. Petroleum Hydröcarbon Scan' (310-13)" 1i Glycolõ) 12. Acid Extractábles: (625/827,0)* 13: Base Neutral'Extractables„ (625/8270) CGOMS Semivolatile Uniknown Scan 15. Pürgeable Halocarbons (DEF) 16. Purgeable Aromatics. (DEF) 17. Pësticides/PCB's (DEF) 18. Other: meta (59) Potassium 60. Selenium 61.Silver -62. Sodium 63. Thallium, 64: Vanadium: 65. Zinc CLP 66 Metals/CN) :67? Volątiles} i68Semi-violatiles.. 69. Pesticides/PCB'S) 70 Disk Deliverables; "ICLP 171 TCLP-Metals) 72:TCLP-Pesticides (73 TCLP-Herbicidễs} 74: TÖLP:Volatiles 75:TCLP-BNAS). NYC-WTC_000071876