Chain of custody record, Westchester County Department of Labs

NYC 9/11 Public Portal Document t

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM

ML wl/Date Set: * WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road. Valhalla. New York 10595 (914)593-5575 __________ C t H NYS-E|j^.No. 10108 ~ 'Fo'rm X-7y(rev. 1/96)

Sample Type (circle one): Bottle #^ ~ S *■__________________ 1.'Potable 3. Non-Potable Treated 2. Non-Potable 4. Other Chain of Custody? .yes no • I Time/Date Collected: Comments: Collectedly: z- .A./,/■A ' ~ Agency Code: PWS #:_________ Source ID: Type Descriptor:. Collected From/ 1 ■ • Bill to: Location's/lndividuars Name M tU-lr fF ’ Name/Company Street________ Street__________ Crtv/St/Zip ■ . ; City/SVZip______ Identification of Source_ Phone#:, Fax #: Collection Point- ;: ■ -'' £2^5. I CA, CH, Bl? Check#:____ L Amounts.

BACTERIOLOGICAL ANALYSES >-^ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLE/SOLID ANALYSES Lab#:__:iLi:;E:l<2:4^ ^b . (circle tests) - \ ft. • ; :: ■ISrcle tests) W* 1. HeterotrophicPIate -5 *1. Trihalomethanes (524) 1. Purgeable Halocarbons (624/8260) Count (herpodial)/sis & others) .Volatile Halocarbons (524) 2. Purgeable Aromatics (624/8260) 2. Coliform P/A (public.'suppliesj.. Volatile Arorhatics (524) 3. Acrolein & Acrylonitrile (624) 3. Coliform MPN (priv well. raw. stp) 4. Total Trihalomethane Potential (510) 4. Phthalates (606/8060) 4. Fecal Co!iform;(all samples) 5. Microextractables (504) - 5. Organochlorine Pesticides (608/8080) 5. Microscopic ■ ■ '. 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) 9» Herbicides (515) 9. Petroleum Hydrocarbon Scan (310-13) 0. Pesticides (525) 10. Glycols in Water Refrigerated? ' 1 yes ■ nd 11. Carbamate Pesticides (531) 11. Acid Extractables (625/8270) ^'12. Glyphosate (547) 12..Base Neutral Extractables (625/8270) Chlorinated?: ■•'ves no . 43. Diquat (549) ^/GC/MS Unknown Scan 4 ' 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)

pH : 77^?;: yr INORGANIC ANALYSES REQUESTED - Lab#: (circle tests) ' - ‘ ‘ 1. Color . "7 20. Acidity 39. Aluminum 59. Potassium 2. T urbidity 21. Alkalinity, as CaCOs 40. Antimony 60. Selenium 3.. pH' 22. Bromide 41. Arsenic 61. Silver 4. Conductivity j;. 23. Bromate/Chlorate/Chlorite 42. Barium 62. .Sodium 5. Corrosivity (temp: °C) 24. Chloride 43. Beryllium 63. thallium ■ 25. Cyanide 44. Boron 64. Vanadium K. 6. BOD (5 day) 7. Soluble BOD (5 day) , , . 26. Fluoride 45. Cadmium 65. Zinc__________ 8. Carbonaceous BOD (5 day) 27. Hardness. Total as CaCOs 46. Calcium, as CaCOs 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 lolids, Percent (%) 32. Oil and Grease 51. Copper 70. Disk Deliverables lolids. Settleable 33. Phenol 52. Iron ISLE 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. IIV254 57. Molybderium 75. TCLP-BNA's SlNlckel

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