Chain of custody record, Westchester County Department of Labs

NYC 9/11 Public Portal Document

HI ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 V H ?■ UlMtchMt* County NYS-ELAP No. 10108 (914) 593-5575 • Date Set:_________ Form A-70 (rev. 1/96) 'L; — Sample Type (circle one): 1. Potable 3. Non-Potable Treated Bottle #'s:JL_:_lAi_L. I -I 2. Non-Potable 4. Other_____________ Chain of Custody? yes no Time/Date Collected:. ) to - i... ti',4." Comments:__________ Collected By:_ ZI .Agency Code: PWS #:;.Source ID:. Type Descriptor:. Collected From: ' x Bill to; Location’s/lndiyidual's Name_SsiiV_Z_L^ Name^ompany Street . ■ ___________________ Street_______________ _ __________ City/SVZip - ____________ City/St/Zip________ Identification’ of Source___________ ____________ Phone#: Fax #: Collectioh Point, S \ 0 • |CA, CH. Bl?- - Check#:, ~ Amount$

BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLE/SOLID ANALYSES Lab#: ■' ■ \■ Lab _______ (circle tests) • (circle tests) 4 '\J V' Tj 1. Heterotrophic Plate' . 1. Trihalomethanes (524) ■ .1.'Purgeable Halocarbons (624/8^60)^/ ' Count (hemodtalysis'& all others) • <2?j Volatile Halocarbons (524) • 2. Purgeable Aromatics (624/8260)"- t 2. Coliform P/A (public supplies) ^3/ Volatile Aromatics (524) 3. Acrolein & Acrylonitrile (624) 3. Coliform MPN, (priv welt, raw, stp) 4. Total Trihalomethane Potential (510) 4. Phthalates (606/8060) J ; * 4. Fecal Coliform (all samples) ■ 5. Microextractables (504) 5. Organochlorine Pesticides (608/8080) 5. Microscopic . ; ; ■ Pesticides (507) '6. PCB’s (Arochlors) (608/8080) . 6. Macroscopic (y Pesticides/PCB screen (508) 7. Herbicides (SM-18/6640; 8151) ' ' ’£2 8. PCB as Decachlorobiphenyl (508A) 8. Other Pesticides (SM-18/6630) s., a-w 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) 12-Base Neutral Extractables (625/8270) Chlorinated?: ves.no 13. Diquat (549) ^3JGC/MS Unknown Scan

Free Chlorine Res:. mg/L 14. Chlorination Disinfection Byproducts (551) 15. Haloacetic Acids (552) 14. Purgeable Halocarbons (DEF) 15. Purgeable Aromatics (DEF) ^3 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)

INORGANIC ANALYSES REQUESTED - Lab#;. (circle tests) ( •v,-* 1. Color 20. Acidity 39. Aluminum 59. Potassium] tj.; 2. Turbidity 21. Alkalinity, as CaCOs 40. Antimony 60. Selenium 3. pH 22. Bromide 41. Arsenic 61. Silver A f 4. Conductivity 23. Bromate/Chlorate/Chlorite 42. Barium 62. Sodium ii 5. Corrosivity (temp: .’C) 24. Chloride 43. Beryllium 63. Thallium j 6. BOD (5 day) • 25. Cyanide 44. Boron 64. Vanadium' 7. Soluble BOD (5 day) 26. Fluoride 45. Cadmium 65. Zinc I 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 ^^olids. Percent (%) 32. Oil and Grease 51. Copper 70. Disk Deliverables ^Bolids, Settleable 33. Phenol 52. Iron TCLP l^^olids. 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 -

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