Chain of custody record, Westchester County Department of Labs

NYC 9/11 Public Portal Document

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM

ML Wre/DateS^ It*' A WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 (914)593-5575 - . > S NYS-ELAP No. 10108._. form A-70 (rev. 1/96) Sample Type (circle one): 1. Potable 3. Non-Potable Treated -17 Bottle ip:i. - 2 J .’-t ---- HI? Ik' 2. Non-Potable 4. Other_____________ _ Chain of Custody? .yes no Time/Date Collected:. / A •’ Comments: Collected By: nri'LJ^/A H /fi,aencv Code: .Type Descriptor:. _ PWS #:_________ .Source ID:. Collected From: Bill to: Location’s/lndiyidual’s Name, MittVft'U iSx Name/Company Street '■ -y ’ ' Street__________ City/St/Zip ' , ■ . City/St/Zip Identification of Source. . Phone#: _Fax #:. Collection PointJ - ; I CA, CH. Bl?. Check#: Amounts.

BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLE/SOLID ANALYSES Lab #:_______ '■ ________ ;_________ (circle tests) k-' . (circle tests) 1. Heterotrc^hic Plate’.'>'’ ■ . • 1. Trihalomethanes (524) 1. Purgeable Halocarbons (624/8260) Count (hemodialysis &'all others) zS Volatile Halocarbons (524) 2. Purgeable Aromatics (624/8260) 2. Coliforrh P/A.(public supplies) Volatile Aromatics (524) . 3. Acrolein & Acrylonitrile (624) 3. Coliform MPN. fpriv well, rayy, stp) 4. Total Trihalomethane Potential (510) 4. Phthalates (606/8060) 4. Fecal Coliform (’ajl samples) . 5. Microextractables (504) 5. Organochlorine Pesticides (608/8080) 5. Microscopic ; ■ ’ 6,. Pesticides (507) 6. PCB's (Arochlors) (608/8080) 6. Macroscopic . Pesticides/PCB screen (508) 7. Herbicides (SM-18/6640; 8151) 8. , PCB as Decachlorobiphenyl (508A) 8. Other Pesticides (SM-18/6630) lUlh e r: ■ Herbicides (515) 9. Petroleum Hydrocarbon Scan (310-13) Pesticides (525) 10. Glycols in Water Refrigerated? 'yes .no 11. Carbamate Pesticides (531) 11. Acid Extractables (625/8270) 12. Glyphosate (547) I^Base Neutral Extractables (625/8270) Chlorinated?: iyes:J no 13. Diquat (549) . ^GC/MS Unknown Scan 14. Chlorination Disinfection Byproducts (551) 14. Purgeable Halocarbons (DEF) Free Chlorine Res:. .mg/L 15. Haloacetic 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) 5 \ i '■

INORGANIC ANALYSES REQUESTED - Lab#: (circle tests) «' 1. Color 20. Acidity 39. Aluminum 59. Potassium 2. Turbidity 21. Alkalinity, as CaCOa 40. Antimony 60. Selenium 3. pH 22. Bromide 41. Arsenic 61. Silver 4. Conductivity 23. Bromate/Chlorafe/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) . V 26. Fluoride 45. Cadmium 65. Zinc 8. Carbonaceous BOD (5 day) 27. Hardness, Total as CaCOa 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-volatiles 12. Total Organic Halides 31. Nitrogen, Total Kjeldahl as N 50. Cobalt 69. Pesticides/PCB's olids, Percent (%) 32. Oil and Grease 51. Copper 70. Disk Deliverables olids. Settleable 33. Phenol 52. Iron TCLP 15. Solids. Suspended 34. Phosphorus. Total as P 53. Lead 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. I.IV254 57. Molybdenum 75. TCLP-BNA’s 58. Nickel ■■•ihi

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