Chain of custody record, Westchester County Department of Labs

NYC 9/11 Public Portal Document

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ER ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM lester WESTCHESTER COUNT? LABORATORIES AND RESEARCH fov.com 2 Dana Road, Valhalla, New York 10595 (914) 593-5575 "^^/Date Set: NYS-ELAP No. 10108 Form A-70 (rev. 1/96)

^mple Type (circle one): ; )..• Potable 3. Non Potable Treated Bottle #’s:_______________________________________________ 2. Non Potable 4. Other Chain of Custody? yes___ no Time/Date Collected: Q. Comments: Collected By: _ YlLaL Agency Code: PWS #:________ Source ID: Type Descriptor: Collected From: Bill to: Location’s/lndividual’s Name Name/Company Street________ _____________________ 2_______ Street_________ City/St/Zip .. _______________________ City/St/Zip ’•'Identification of Source'jyZ- <<? /y Phone#:_______ Fax#: yQollection Point >» ■ 7 T- I CA,CH, Bl? Check#: Amount$^2

BACTERIOLOGICAL ANALYSIS ORGANIC POTABLE ANALYSIS. ORGANIC NONPOTABLEZSOLID ANALYSIS ;. Lab#: ‘ . Lab#:____ 'y / J ,, (circle tests) , (circle tests) Lr / / 1. Heterotrophic Plate 1. Trihalomethanes (524) 1. Purgeable Halocarbons (624/8260) Count (hemodialysis & all others) Volatile Halocarbons (524) 2. Purgeable Aromatics (624/8260) 2. Coliform P/A. (public supplies) J? Volatile Aromatics (524) 3. Acrolein & Acrylonitrile (624)' ' 3. Coliform MPN (privwell, raW'st^ 4. Total Trihalomethane Potential (510) 4. Phthalates (625/8270) 4. Fecal Coliform (alj samples) 5. Microextractables (504) 5. Organochlorine Pesticides (608/8081) 5. Microscopic Pesticides (507) \ 6. PCB’s (Arochlors) (608/8081) 6.^^roscopic Pesticides/PCB screen (508) 7. Methoprene (616) 8. PCB as Decachlorobiphenyl (508A) 8. Herbicides (EPAI 978/8151) > 8. Other: 9. Herbicides (515) 9. Pesticides (SMI 8/6630) Refrigerated?yes no Pesticides (525) 10. Petroleum Hydrocarbori Scan (310-13) n. Carbamate Pesticides (531) 11. Glycols '.-r Chlorinated:? yes no 12. Glyphosate (547) 12. Acid Extractables (625/8270) o 13. Diquat (549) 13. Base Neutral Extractables (625/8270) Free Chlorine Res: mg/L 14. Chlorination Disinfection Byproducts (551) ly^C/MS Semivolatile Unknown Scan Total Chlorine Res: mg/L 15. Haloacetic Acids (552) Purgeable Halocarbons (DEF) 16. Pesticides (SMI8/6630) 16. Purgeable Aromatics (DEF) pH 17. Petroleum/Hydrocarbon Scan (310-13) 17. Pesticides/PCB’s (DEF) 18. Other:__________________________ 18. Other:. /•

INORGANIC ANALYSIS REQUESTED - Lab#: (circle tests) 1. Color 20. Acidity 39. Aluminum 59. Potassium' 5 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 CaCOa 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-violatiles 12.'Total Organic Halides 31. Nitrogen, Total Kjeldahl as N 50. Cobalt 69. Pesticides/PCB’s l^olids. Percent (%) 32. Oil an Grease 51. Copper 70. Disk Deliverables iSnlids, Settleable 33. Phenol 52. Iron 53.Lead IGLE 1 STSolids, Suspended 34. Phosphorus Total as P 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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