Chain of custody record, Westchester County Department of Labs

NYC 9/11 Public Portal Document - —I...

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM ;ster iv.com WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 (914) 593-5575 NYS-ELAP No. 10108 IS ate Set: k- ? S ' 7; I. kS' Porm A-70 (rev.1/96) (J 7-r'7^ Sam£[e Type (circle one): i 1. Potable J 3. Non Potable Treated Bottle #’s: a

2. Non Potable 4. Other Chain of Custody? yes no Time/Date Collected: _ Comments: A*- Collected By: ~"l-y > Q Agency Code: PWS #:________ Source ID: Type Descriptor: Collected From: Bill to: Location’s/lndividual’s Name '2? ' Name/Company _ Street_________________________ Street_________ City/St/Zip____________ L________ City/St/Zip Identification'of Source *5_______ Phone#:_______ Fax#: ____________________________________________________________ ■■

Collection Point______ .^2-^ I CA.CH, Bl? Chectoif:' Amounts-- r. / 4

BACTERIOLOGICAL ANALYSIS ORGANIC POTABLE ANALYSIS ORGANICNONPOTABLE/SOLIDANALYSIS' Lab#:___________ ‘ ■ Lab#:_______________ '________ (circle tests) 't (circle tests) . ‘ .) a

1. Heterotrophic Plate 1. Trihalomethanes (524) 1. Purgeable Halocarbons (624/8260) Count (hemodialysis & .air others) '15S Volatile Halocarbons (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) 4. Total Trihalomethane Potential (510) 4. Phthalates (625/8270) 4. Fecal Coliform (all samples) 5. Microextractables (504) 5. Organochlorine Pesticides’(608/8081) 5. ^^oscopic . / 6. Pesticides (507) 6. PCB’s (Arochlors) (608/8081) ' 6. ^^oscopic Pesticides/PCB screen (508) 7, Methoprene (616) PCB as Decachlorobiphenyl (508A) 8. Herbicides (EPA1978/8151) ' 8. Other:__________________ Herbicides (515) 9. Pesticides (SMI8/6630) , Pesticides (525) 10. Petroleum Hydrocarbon Scan (310-13H Refrigerated?yes no Carbamate Pesticides (531) 11. Glycols Chlorinated:? yes___ no 12. Glyphosate (547) 12. Acid Extractables (625/8270) 13. Diquat (549) 13. Base Neutral Extractables (625/8270) Free Chlorine Res:. mg/L 14. Chlorination Disinfection Byproducts (551) (^GC/MS Semivolatile Unknown Scan 15. Haloacetic Acids (552) 15. Purgeable Halocarbons (DEF) 5 Total Chlorine Res: mg/L 16. Pesticides (SMI8/6630) 16. Purgeable Aromatics (DEF) pH 17. Petroleum/Hydrocarbon Scan (310-13) 17. Pesticides/PCB’s (DEF) ■j j' N— 18. Other:__________________________ 18. Other:.

INORGANIC ANALYSIS REQUESTED - Lab#: (circle tests) 1. Color 20. Acidity 39. Aluminum 59. Potassium 2. Turbidity 21. Alkalinity, as CaCOs 40. Antimony 60. Selenium 3. pH 22. Bromide 41. Arsenic 61. Silver 4. Conductivity 23. Bromate/Chlorate/Chlorite 42. Barium 62. Sodium 5. Corrosivity (temp:. .®C) 24. Chloride 43. Beryllium 63. Thallium 6. BOD (5 day) 25. Cyanide 44. Boron 64. Vanadium 7. Soluble BOD (5 day) 26. Fluoride 45. Cadmium 65. Zinc 8. Carbonaceous BOD (5 day) 27. Hardness, Total as CaCOs 46. Calcium, as CaCOa CLP 9. Chemical Oxygen Demand 28. Nitrogen, Ammonia as N 47. Calcium, Ca*^ 66. Metals/CN 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-violatiles 12."Total Organic Halides 31. Nitrogen, Total Kjeldahl as N 50. Cobalt 69. Pesticides/PCB’s 1 lids, Percent (%) 32. Oil an Grease 51. Copper 70. Disk Deliverables 1 lids, Settleable 33. Phenol 52. Iron 34. Phosphorus Total as P 53.Lead I£kP 15. Solids, Suspended 71 TCLP-Metals 16. Solids, Total 35. Phosphorus, Ortho as P 54 Magnesium 72.TCLP-Pesticides 17. Solids, Total Dissolved 36. Sulfates 55 Manganese 73. TCLP-Herbicides 18. Solids, Total Volatile 37. Surfactants 56. Mercury 74. TCLP-Volatiles 19. Other:____________ 38. UV254 57 Molybdenum 75.TCLP-BNA’s 58. Nickel

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